Building the Capacity of California's Safety Net: Lessons From the Strengthening Community Dental Practices Demonstration
| Autor: | Len Finocchio, Clare Nolan, Fontane Lo |
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| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | The Foundation Review. 4:28-39 |
| ISSN: | 1944-5679 1944-5660 |
| DOI: | 10.4087/foundationreview-d-11-00029 |
| Popis: | Keywords: Safety net, capacity building, California, dental, oral health, health reformIntroductionGrantmakers are increasingly interested in strengthening nonprofit capacity to improve program performance and ensure the sustainability of community-based programs in the face of an economic downturn. However, the literature on effective models for nonprofit capacity building is still emerging (Silverman et al., 2001). Likewise, evaluators have been challenged to find meaningful measures of organizational effectiveness and development, along with methods that capture the true impact of capacity-building initiatives (Backer, Bleeg, & Groves, 2010).This article describes the results of a demonstration project funded by the California HealthCare Foundation (CHCF) and the California Pipeline Program (CPP) that sheds light on both these issues. The purpose of the Strengthening Community Dental Practices (SCDP) demonstration was to assess the effectiveness of practicemanagement consulting in helping California's safety-net dental practices survive and thrive. The SCDP capacity-building model provides customized technical assistance to enhance the business infrastructure behind the delivery of care. The SCDP evaluation revealed that most clinics exhibited substantive improvements in clinic operations and financial performance. The experiences of participating clinics pointed to several factors that create an environment for success. CHCF is now implementing a second phase of the project that builds on lessons learned from the demonstration.This article first describes capacity issues facing safety-net dental practices and provides an overview of the SCDP demonstration. It then discusses CHCF's and CPP's joint interest in evaluation, the conceptual framework and methodology used to evaluate the initiative, and the findings from this work. This is followed by a discussion of lessons learned for grantmakers and others interested in both designing and evaluating nonprofit capacity-building initiatives.The Strengthening Community Dental Practices DemonstrationCommunity health centers play a crucial role in providing access to dental services for California's underserved populations. However, a statewide fiscal crisis compounded by the recent economic downturn has created unprecedented challenges for community dental practices across the state. These trends threaten the sustainability of safetynet dental clinics and may ultimately reduce access to care for many low-income and uninsured Californians:* The California Legislature eliminated most Medicaid dental benefits for adults effective July 2009.1 This public program had been the primary payer source for most safety-net dental clinics in the state and was a vital source of coverage for more than 3 million Californians (Hughes & Diringer, 2009).* As resources are waning, the demand for safety-net services is rising. California's high unemployment rate (12 percent as of August 2011) speaks to the rising uninsured population.* Many dental practices are faced with reduced funding from private foundations and local agencies. Without these funds, clinics will find it difficult to subsidize care for the uninsured.Even as challenges mount, there are still opportunities for growth through the Patient Protection and Affordable Care Act of 2010 (ACA) and the American Recovery and Reinvestment Act of 2009 (ARRA). Provided clinics can contain costs, ACA presents an opportunity for clinics to strengthen their services, networks, and infrastructure (Katz, 2010). Furthermore, under ARRA, federally qualified health care centers (FQHCs) nationwide were allotted $1.5 billion of infrastructure improvement funding and $500 million of operations funding (National Association of Community Health Centers, 2009). As more health centers move toward electronic record systems, there is potential to improve the operational efficiency of safety-net dental clinics. … |
| Databáze: | OpenAIRE |
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