Page 113 - JCTR-11-4

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

resources (i.e., organizational and workforce capacity), and develop and evaluate adaptations under the intense time
school policies/response to SBDSPs’ re-implementation pressures and resource constraints posed by a health or
(e.g., inter-organizational communication). These observed environmental crisis. 66,67 Secondly, there was no evaluation
re-implementation patterns broaden the existing literature of the negative impact on oral health of not having developed
by describing re-implementation efforts, adaptations, and these partial re-implementation strategies. Post-COVID
re-implementation factors influencing program variability research has found that prolonging the de-implementation
in reaching full re-implementation following crisis-related of school-based dental services was associated with: (i)
disruptions. 23 delayed access to dental care, (ii) poor oral hygiene, (iii)
increased prevalence of dental caries, and (iv) a decline in
4.2. Adaptation’s role in re-implementation dental prevention services utilization. 68-72 This reinforces
None of the SBDSPs had a proactive crisis management findings from broader public health literature that delays
plan ahead of the COVID-19 crisis. However, some in re-implementation following service disruption are
programs developed crisis-induced transformational associated with worsened health outcomes, particularly in
(i.e., fundamental) adaptations, such as virtual oral health underserved populations. 73,74
education programs or alternative care delivery settings. 23,60
These adaptations enabled partial re-implementation of 4.3. Factors influencing re-implementation patterns
SBDSPs. In the context of full and gradual re-implementation This study highlights the impact of SBDSPs’ resource (i.e.,
patterns, such adaptations acted as interim mechanisms organizational and workforce capacity) availability during
to preserve elements of program delivery and maintain de-implementation and re-implementation. The prolonged
organizational engagement with school systems. However, de-implementation of SBDSPs resulted in the loss of program
their effectiveness was contingent upon alignment with personnel, and rebuilding the workforce became a critical step
school policies, staff readiness, and resource availability. for re-implementation. Programs that were re-implemented
Importantly, the school’s response to these adaptations more rapidly tended to have larger organizational
and the re-implementation of SBDSPs varied considerably infrastructure and access to internal clinical services, which
across the cases. In full re-implementation contexts, collectively supported workforce maintenance and quicker
the school system (i.e., schools and school districts) re-implementation of SBDSPs. In contrast, programs that
offered consistent support and clear communication were re-implemented gradually were smaller organizations
channels. Conversely, in cases of gradual and slow with fewer resources and faced greater challenges,
re-implementation, program staff experienced uncertainty highlighting the critical role of organizational resources in
due to unclear directives and inconsistent school district managing workforce losses during de-implementation and
policies. Furthermore, variations between and within the rebuilding them for re-implementation.
school districts’ COVID-19 mitigation strategies, policies, These results are consistent with prior research showing
and adaptations led to a chaotic SBDSP re-implementation that, under non-crisis conditions, insufficient staff size
process that delayed full re-implementation. These findings affects all aspects of the implementation process, including
are consistent with the literature in other fields, indicating program planning, implementation, fidelity, sustainability,
that conflicting, ambiguous, or overly complex policies and reach. 15,48,75-77 Our findings reinforce this literature
contribute to implementation delays, even under non- by demonstrating how these challenges become more
crisis conditions. 61-63 Therefore, programs that introduced pronounced during a crisis. The differential ability of
adaptations without concurrent organizational support or larger versus smaller organizations to retain or redeploy
key informants’ buy-in (e.g., schools, school district nurses) staff suggests that baseline organizational infrastructure,
experienced limited traction, underscoring the importance resources, and support are key determinants of
of co-developed adaptation strategies during crisis contexts. re-implementation capacity in crisis contexts. 23
These findings highlight the critical need for organizational At a fundamental level, program recovery was hindered
readiness and multi-level systems coordination, ensuring by the loss of personnel who may have been valuable to the
adaptations during a crisis are not only implemented but crisis management process. Inexperience and the absence
also effectively aligned, integrated, and accepted. 23,27,64,65 of crisis management training may have exacerbated
Several questions arise from our findings on partial delays in crisis management and hindered crisis
re-implementation. First, it was not feasible for SBDSPs to management teams’ ability to cope with rapid workforce
conduct evaluations of the adapted programs within the disruption. Prior work under crisis conditions suggests
crisis context. That is, neither the field of implementation that a lack of preparedness negatively impacts workforce
science nor crisis management addresses how to effectively capacity. Consistent with this, our data findings suggest
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Volume 11 Issue 4 (2025) 107 doi: 10.36922/jctr.24.00074