Page 109 - JCTR-11-4

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

3.2. De-implementation and crisis management that SBDSPs are adjacent to the central crisis, and it is
development atypical for such programs to have crisis management
plans in advance of a crisis. In addition, none of the cases
As seen in Table 3, the de-implementation phase ranged
from 3 months (Case 4) to 21 months (Case 6). In terms formed key informant committees, used specific crisis
of the total observation window (3 years), Case 6 faced management guidance (i.e., a formal planning model),
complete de-implementation approximately 58% of the or obtained expert consultation on crisis management.
However, two cases (Cases 3 and 4) received additional
time compared to only 8% for Case 4. In subsequent input from an external organization that provided these
sections, we will examine the reasons for the variations in
the de-implementation phase. programs’ management and quality assurance oversight.
De-implementation also had a significant effect on
During de-implementation, most SBDSPs developed
informal crisis management teams (Cases 1, 3, 4, 5, and 6), workforce disruption. Four FQHCs SBDSPs/organizations
maintained their workforce during de-implementation
while Case 2 relied on the program director to make crisis
management decisions. Among the five SBDSPs with by transferring workers to different departments or
COVID-19-related programs in the parent organizations
informal crisis management teams, four of them were (e.g., COVID-19 testing and vaccination clinics). The
FQHC SBDSPs/organizations (i.e., 3, 4, 5, and 6), and the remaining two SBDSPs reported reducing (Case 1) or
remaining case (Case 1) was a non-profit organization. completely losing (Case 2) their workforce during the
Unlike the non-profit organizations, the FQHCs were de-implementation phase.
more directly involved in the crisis management of the
SBDSPs and offered more human capital (i.e., parent 3.3. Re-implementation patterns and timelines
organizations’ dental directors [n = 4]) to address crisis Our analysis revealed that SBDSPs initiated and adapted
management development and decision-making. Case 2, a various strategies to re-implement program services at
smaller organization with fewer employees, was unable to different points in time. Case 4 spent 33 months engaged in
develop a crisis management team.
re-implementation activities, while Case 6 spent 15 months
Among cases who reported having developed crisis engaged in re-implementation over the 3-year observation
management teams, the teams typically consisted of 2–3 window of the study. Some re-implementation strategies
members (e.g., SBDSPs managers, dental directors, and/or were implemented outside of school venues to meet the
dental providers; Cases 1, 3, 4, 5, and 6) and met remotely, pandemic guidelines.
weekly to bi-monthly. The content of the crisis management In addition, our study found that programs were
meetings focused on COVID-19 infection control re-implemented at varying capacities compared to
protocols, staff size and training, school re-engagement before the COVID-19 crisis. A review of Table 4 and
timelines, consent form updates to include COVID-19 Figure 1 illustrates our findings regarding the different
mitigations, and modifications needed to the program’s patterns in the re-implementation process, including
delivery processes. Most importantly, all crisis management partial, intermediate, and full re-implementation. The
teams reported discussing plans for re-implementation.
implementation patterns are not sequential; programs
None of the cases had proactively developed crisis may initiate full re-implementation without partial or
management teams or plans. It is important to notice intermediate re-implementation (e.g., Cases 3 and 5).

Table 3. De‑implementation and re‑implementation pattern timelines by months
Case De‑ Re‑implementation Total
implementation Partial Intermediate Full re‑implementation
Months Percentage Months Percentage Months Percentage Months Percentage Months Percentage
3 15 42 0 0 0 0 21 58 21 58
5 18 50 0 0 0 0 18 50 18 50
4 3 8 18 50 3 8 12 33 33 92
2 15 42 15 42 0 0 6 17 21 58
1 6 17 9 25 21 58 0 0 30 83
6 21 58 0 0 15 42 0 0 15 52
Note: Cases are ordered based on the timing of achieving full re-implementation (earliest to latest).

Volume 11 Issue 4 (2025) 103 doi: 10.36922/jctr.24.00074