Page 111 - JCTR-11-4

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

Additionally, partial re-implementation also occurred 3.4. Full rapid re-implementation
when programs began providing services at the schools Cases 3 and 5 fully and rapidly re-implemented their
(i.e., not all core components were provided) (i.e., Case 2). SBDSPs in 2021 (Figure 1). They provided all SBDSP
Furthermore, the ability to swiftly rebuild the workforce core components to the same number of schools they
(Cases 2 and 4) allowed for rapid re-implementation. served before the pandemic. Among all the cases, they
Although Case 1 was not able to maintain its workforce initiated full re-implementation earlier and, consequently,
during de-implementation, a complete workforce was not had the longest span of full implementation services
necessary for partial re-implementation since the program during our 3-year observation period (21 – 18 months,
was not operating at full capacity. respectively) (Table 3). Cases 3 and 5 were the only cases
Organizational size and resources (e.g., staff size, to fully re-implement their SBDSPs without first going
affiliation to dental clinics, and funding) did not through partial or intermediate re-implementation. Both
seem to be contributing factors to successful partial SBDSPs’ crisis management teams decided not to conduct
re-implementation. However, one of the larger FQHC partial re-implementation to marshal their resources
organizations (Case 4) had a dental clinic that provided for full implementation when the schools were ready
additional workforce opportunities when the SBDSP’s to host the program. Contributing factors to full rapid
program was de-implemented. Smaller organizations were re-implementation included:
successful in partially re-implementing their SBDSPs. (i) SBDSPs resources (organizational and workforce
Even though Case 1 is a small nonprofit organization, it capacity). Cases 3 and 5 maintained their workforce
was able to make crisis management adaptations feasible during de-implementation (transferred SBDSP
and successful through fundraising. workforce to other departments within the
parent organization) and rapidly rebuilt it for
3.3.2. Re-implementation rates re-implementation. Both cases were FQHCs and
utilized similar resources with dental clinic affiliations
Using a Gantt chart and pattern analysis, we further and valuable organizational resources (i.e., financial
identified and subcategorized each case into one of three and human).
distinct subcategories. This subcategorization considers the (ii) School response (COVID-19 policies and inter-
rate at which SBDSPs move through the re-implementation organizational communication). Cases 3 and 5
patterns. The re-implementation timelines are displayed had efficacious communication with the schools
in terms of the standard academic quarters broken out and experienced positive school responses
by winter, spring, summer, and fall (i.e., we used this to re-implementation. Neither case reported
division despite some schools being on semesters rather COVID-19 school-related policy challenges during
than quarters) (Figure 1). We stratified SBDSPs into re-implementation.
three subcategories reflecting the rate at which they were
re-implemented (rapid, gradual, and slow): 3.5. Full gradual re-implementation
(i) Full rapid re-implementation: Refers to the cases Cases 2 and 4 initiated partial re-implementations prior
observed to be the first to re-implement their SBDSPs to transitioning to full re-implementation (Figure 1). Both
fully (all SBDSP core components were delivered to Cases 2 and 4 made a deliberate decision to implement partial
all the schools served before the COVID crisis) (i.e., re-implementation adaptations because they believed that
Cases 3 and 5). this would facilitate the return to full implementation
(ii) Full gradual re-implementation: Refers to the cases down the road. Unfortunately, this goal was not realized. In
observed to gradually reach full re-implementation by particular, Cases 2 and 4 were confronted with schools that
re-implementing SBDSPs partially or intermediately were reluctant to allow full re-implementation at an earlier
before reaching the full re-implementation (i.e., date. By our definitions, these cases were categorized
Cases 2 and 4). Although these cases reached full as full gradual re-implementation. Case 4 was the first
re-implementation, their timeline was longer than SBDSP to initiate partial re-implementation 3 months
those in the full rapid re-implementation category. after de-implementation (Table 3). Case 4 also spent
(iii) Intermediate slow re-implementation: Refers 3 months in intermediate re-implementation, wherein
to the cases observed to never reach the full they provided full services to some, but not all, of their
re-implementation, as defined in this study (Table 4) pre-pandemic schools. Overall, Case 4 had the longest
during the 3-year study period, and only reached span of total re-implementation (i.e., 33 months) during
intermediate re-implementation compared to other our 3-year observation period. Case 2, on the other hand,
cases in the study (i.e., Cases 1 and 6). progressed from partial to full without going through

Volume 11 Issue 4 (2025) 105 doi: 10.36922/jctr.24.00074