Page 112 - JCTR-11-4

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

intermediate re-implementation (i.e., they initiated full period of intermediate re-implementation. The
re-implementation in their entire pre-pandemic school prolonged intermediate re-implementation, paired with
network). failure to reach full re-implementation, stemmed from
programmatic decisions, particularly the reduction in
3.5.1. SBDSPs resources (organizational and the number of schools served. The programs’ decision to
workforce capacity) limit their services to elementary schools only caused a

Cases 2 and 4 were of different organizational sizes and reduction in school reach and the inability to achieve full
types, and thus had different resources that influenced re-implementation.
their advancement to full re-implementation. Case 2 was
a small for-profit organization with limited financial and 3.6.1. SBDSPs resources (organizational and
human resources compared to Case 4, a large FQHC workforce capacity)
with abundant resources. The depth of resources allowed Cases 1 and 6 were of different organizational sizes and
Case 4 to maintain its workforce despite voluntary staff types (Case 1: Small nonprofit with limited resources;
turnover, which had no impact on its re-implementation Case 6: Large, FQHC with abundant resources), and thus
because additional resources (i.e., dental clinic) provided may have had different resource capacities to devote to
staff to fill those vacancies. Case 2 also rapidly rebuilt its re-implementation. Case 1’s SBDSPs were short-staffed,
workforce after the catastrophic loss of workers during and the program was not able to maintain or rebuild its
de-implementation. dental providers. Case 1 differed from other cases in the
study in that it had a mixture of direct and subcontracted
3.5.2. School response (COVID-19 policies and inter- workforce. During de-implementation, Case 1 was only
organizational communication)
able to maintain its direct staff. As a result, the number
The gradual transition from partial to intermediate to of subcontracted dental providers declined from 13 to 3,
full re-implementation was influenced by program-to- resulting in significant workforce challenges. Case 6 had
school communication challenges and unevenness in a change in management, which might have prolonged
the school systems’ decisions and policies throughout de-implementation and slowed decision-making processes.
the re-implementation process. Despite having open
communication channels and being included in the schools’ 3.6.2. School response (COVID-19 policies and inter-
re-opening blueprints, delays in re-implementation were organizational communication)
experienced by Case 4 due to inconsistent messages Case 1 maintained open communication with the schools
from the schools and COVID-19 policies (i.e., schools in its service area, while Case 6 did not. As expected,
in the services area limited the number of non-essential Case 6 faced more challenges with the school’s response
personnel (SBDSP staff) from entering the schools). and policies towards re-implementation than Case 1. One
Case 2’s program-to-school communication changed school district in Case 6’s service area required all SBDSPs
significantly (i.e., school district-level nurses acted as providing services at their schools to be vaccinated, while
school gatekeepers); in turn, the program no longer had the other district did not. The conflicting vaccination
direct contact with the schools compared to before the policies enacted by the schools in conjunction with poor
pandemic. As a result of the disruption in communication, SBDSP-to-school communication had a negative effect on
Case 4 had prolonged partial and unanticipated Case 6’s re-implementation. School vaccination policies
intermediate re-implementation, and Case 2 temporarily required Case 6 to add additional workers drawn from
lost access to 6 schools. In summary, challenges in their dental clinic, but these new workers needed training
program-to-school communication and misaligned crisis and time to learn field skills. Consequently, vaccine policies
management practices within the school systems delayed had an indirect impact on delaying full re-implementation.
full re-implementation. Once these challenges were
resolved, SBDSPs were able to reach full re-implementation 4. Discussion
3.6. Intermediate slow re-implementation 4.1. Re-implementation patterns

Cases 1 and 6 were the only two cases that did not reach This study examined the de-implementation and
full re-implementation during our 3-year study period. re-implementation of SBDSPs in the context of a large-
Case 1 spent 21 months, and Case 6 spent 15 months in scale crisis, identifying three distinct re-implementation
intermediate re-implementation, where they provided patterns: Full rapid, full gradual, and intermediate slow
full services to some, but not all, pre-pandemic schools. re-implementation. These patterns were influenced by
Cases 1 and 6 followed different pathways to a prolonged crisis management planning or lack thereof, SBDSPs’

Volume 11 Issue 4 (2025) 106 doi: 10.36922/jctr.24.00074