Page 106 - JCTR-11-4

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

goals such as disease transmission reduction (Dr. Ashley SBDSPs from the perspective of SBDSP administrators and
Schuyler, oral communication, January 5, 2023). Because providers.
neither the field of crisis management nor implementation
science explicitly incorporates adjacent programs in their 2. Methods
planning processes, we expected programs such as SBDSPs 2.1. Sample and study design
to lack formal crisis management plans and instead
respond reactively to unfolding events, which is an area of A list of all SBDSP organizations delivering SBDSPs in
investigation that we examined. Oregon during the 2019–2020 school year was obtained
(n = 20) from the OHA. OHA’s SBDSP (n = 1) and
Based on expert opinions and crisis management participants in our pre-COVID-19 pandemic study
models, effective crisis management planning should (n = 5) were excluded from the sample frame. A stratified
include five key components: Key informants committees, two-stage random list sampling technique was used
planning processes, decision-making and actions, written to select the current study sample. The sample frame
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guidance, and expert consultations. 27,33,36,37,39-41 For of counties (n = 11) and the remaining organizations
instance, involving school personnel, parents, and SBDSP (n = 14) operating SBDSPs were stratified into small
staff in the planning process could help identify challenges (n = 6) and large (n = 5) counties based on each county’s
and necessary adaptations before re-implementation. 39,44 population size. The sample was stratified by county to
In addition, strong program-to-school communication, represent organizational differences (i.e., size and type).
critical under normal conditions, remains essential for It is important to note that multiple organizations may
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successful re-implementation, emphasizing the need for provide services to different schools in the same county;
formal crisis protocols within and between SBDSPs and thus, the number of organizations is not equal to the
the school system. number of counties in the sample list. A first-stage random
Workforce capacity, including adequate staffing and sample selection was obtained using a random assignment
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training, is fundamental to the successful implementation generator, after assigning a number to each county. A
of evidence-based interventions under normal second-stage random selection was conducted when more
conditions. 27,45-49 Conversely, insufficient staffing or high than one organization was operating in one randomly
turnover negatively impact both organizational and selected county. Eight organizations delivering SBDSPs
intervention-level outcomes. 15,50,51 For example, high staff were randomly selected and invited to participate in the
turnover rates have been associated with reduced program study. Two organizations refused to participate, resulting
reach (e.g., school and client recruitment), effectiveness, in a final sample of n = 6 (three/stratum). This number of
and overall implementation quality. 15,48 These workforce cases meets the general criteria (i.e., a minimum of five
capacity issues may be exacerbated during crises, and cases) for analytical generalizability within a multiple-case
inadequate staffing can both hinder crisis response study design. 54,55
and result from poor crisis management planning. We conducted a cross-sectional, embedded multiple-
Therefore, our study emphasizes staff size, turnover, and case study design with organizations delivering SBDSPs as
workforce rebuilding as key factors in understanding the the unit of analysis and personnel within each organization
de-implementation and re-implementation of SBDSPs. as embedded subunits. This design is crucial for
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This research falls under the general rubric of addressing the intricate complexities present in scenarios
implementation science and crisis management, both with more variables of interest than units available for
of which aim to support successful recovery from crisis the analysis. It also allows us to collect the data from
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and deliver evidence-based programs in the real-world multiple sources (i.e., SBDSP personnel) and provides
settings, an area of study that has received limited an in-depth examination of each participant’s experience
attention in existing research. Specifically, the current and perspective. However, it is essential to note that the
study aimed to examine: (i) how SBDSPs were impacted data collected from SBDSP personnel were evaluated and
by de-implementation and how they adapted, if at all, interpreted to make conclusions about the organizations
to school closures, (ii) how de-implementation affected and not about the individuals within the organization. 54
SBDSPs’ ability to maintain their pre-COVID workforce
during school closures, (iii) how crisis management 2.2. Procedures
planning and organizational resources influenced SBDSPs’ Study procedures were approved by the Oregon State
ability to maintain their pre-COVID workforce, and (iv) University’s Institutional Review Board. Participating
school re-engagement, re-implementation timelines, and programs’ directors, managers, and dental hygienists were
factors that influenced the re-implementation processes of contacted individually through E-mail and invited to

Volume 11 Issue 4 (2025) 100 doi: 10.36922/jctr.24.00074