Making the decision to move into a community-based setting for delivery of care requires thought and careful consideration of one’s professional goals. Community-based care may be offered through a large corporation which already has multiple programs in place35,46 or may be a part of a model utilized by a community health center.36,37 However, if no such opportunity exists, the dental professional may have to establish his/her own program for community-based care.
Regardless of the origin of the community-based care, several guidelines should be kept in mind. The first guideline is to remember it takes a team. For example, a person to act as a “navigator” for the population being served will be an important part of scheduling and eliciting patient acceptance of the program. Successful public health programs often cite the role of the navigator or patient coordinator as the key to patient acceptance and compliance.38,47 This “navigator” may be a traditional dental professional such as the dental assistant or dental hygienist or may be someone trained specifically to direct patients through the care process, such as a social worker or community health worker.
Secondly, the dental professional must remember that the delivery process is different than that of traditional private practices and thus may require thinking outside of the box and utilizing the work day differently.48,49 For example, the first hour of the day may be spent in driving to a new location. Periodically a portable clinic may have to be transported which will require dis-assembly and re-assembly of equipment. The schedule may require that the patient appointments be scheduled between other activities at the delivery site. For example, delivery of care in a long-term care facility may require the dental professional work when space is available and when the residents are not otherwise occupied with meals, therapies or social activities. This will alter the number of patients available to treat in a day.
Thirdly, regardless of the setting, community-based care must be sustainable.50 Delivering care in a non-traditional location such as a school, social service center or long term care facility should not be entered into as an act of volunteerism. Volunteerism is good for a time, but may not be a sustainable method of delivery. A dental professional seeking a career in community-based dentistry should decide if he/she has a desire to search for long-term funding. If not, then perhaps a career with a company or health center utilizing the community-based model is the answer. However, if the provider is determined to engage in a program of community-based care that is not funded by a company or already established clinic, there may be a need for business skills and grant writing. The topic of sustainability and securing grants will be discussed later in this course.
A career inventory may be helpful when considering the option of community-based dentistry. Such an inventory, adopted from the Oral Health Kansas Extended Care Permit Toolkit,51 is suggested for your use in making a decision about a career in community-based dental care. This inventory can be found in Appendix A.
Delivering care where people live is an example of care in a community-based setting.