A Volunteers in Health Care Guide · Dental care for poor and low-income populations has received a...

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A Volunteers in Health Care Guide

RECRUITING & RETAINING DENTAL VOLUNTEERS:

Editor's Note: The FTCA Medical Malpractice Program was implemented in 2004 after the completion of this

manual. The FTCA program offers malpractice coverage for clinical volunteers at free clinics that qualify for this

coverage.

HISTORY

The Free Clinics Federal Tort Claims Act Medical Malpractice Program stems from section 194 of the Health

Insurance Portability and Accountability Act of 1996 (HIPAA). Section 194 alters the Public Health Service Act's

provision on liability (42 USC 233) to protect health care practitioners from civil damages if they are volunteering

clinical services at a free clinic. However, due to a clause requiring funding before activation, Section 194 did not

go into effect until initial appropriations for this fund were made in February 2004 (HR 2673). Initial appropria-

tions of $4.85 million for FY2004 were intended to both activate the provision itself and provide “seed money,”

directed to the Health Resources and Services Administration (HRSA), to initiate this program. Once funding was

appropriated, HRSA then promulgated regulations and developed an application process. The program began

enrolling clinics and volunteers in September 2004.

HOW IT PROTECTS

The FTCA program designates licensed health care practitioners that provide a qualifying health service to an indi-

vidual in a free clinic as employees of the US Public Health Service. Under this designation, clinical volunteers

become protected against malpractice claims in the context of their volunteer service. These statutes provide

broad protection with respect to claims for damages for personal injury, including death. Patients, though, may still

bring suit, with all legal costs and awards becoming the responsibility of the federal government.

Clinicians are only covered by this provision, however, if the clinic where they volunteer meets eligibility criteria

and applies for coverage on behalf of the volunteers.

ELIGIBILITY FOR PROTECTION

In order to qualify for protection under this act, the volunteer must be a licensed health care practitioner; must receive

no payment for services; must undergo credentialing and privileging; and must volunteer at an organization that has

been “deemed” eligible for coverage. Both medical and dental providers are covered under this program.

REMAINING QUESTIONS

Due to the early stage of implementation, it is difficult to determine how valuable this new program will be to clin-

ical volunteers. Potential roadblocks for coverage include: a narrow focus of the location of volunteer activities

(can a surgeon be covered for volunteering to provide free surgery to a free clinic patient?), the complexity of the

application process; and the types of programs eligible for coverage (for instance, it is unclear if a referral network

could be covered). The Bureau of Primary Health Care is currently reviewing these questions and is receptive to

input from programs that wish to qualify under the FTCA program.

For further information and an application, please visit the Bureau of Primary Health Care website:

www.bphc.hrsa.gov

FTCA Medical Malpractice Program

1

2

Introduction

Dental care for poor and low-income populations has received a great deal of attention since the U.S.

Surgeon General’s Report, Oral Health in America: A Report of the Surgeon General, was issued in 2000.

This is not to say that disparities in dental care access are only recently recognized. The use of volunteer

dentists to deliver care to the poor goes back at least as far as the early 20th century when free clinics

were established in places like Rochester, NY (1902) and Denver, CO (1912). Dentists have also tradi-

tionally provided free and discounted services from their offices.

Nevertheless, problems of dental access for low-income individuals persist. Although the number of den-

tally uninsured individuals is more than 3 times the rate of the medically uninsured, dental volunteer

efforts1 are significantly outnumbered by medical volunteer programs. In part, this is the case because it

appears to be more challenging to get dentists than physicians to volunteer their services. Volunteers in

Health Care has heard repeatedly from programs across the country about the difficulties in starting and

maintaining programs that use volunteer dentists.

The purpose of this manual is to help you understand some of the challenges of creating a dental pro-

gram using volunteers and to help you with approaches for recruitment and retention. It is primarily

designed for projects that do not already have an active dental volunteer base. We have also included

sample recruitment letters, provider agreements and other useful instruments to help you create or

enhance your dental volunteer base.

VIH

Volunteers in Health Care (VIH) was a national resource center for health care providers and programs

serving the uninsured, with a special focus on programs using volunteer clinicians. VIH’s mission was to

promote and support organized, community-based health care initiatives with one-on-one technical assis-

tance, consulting services, the creation of hands-on tools and the sharing of service models, experiences

and information. Through its three program areas—volunteer supported medical services, oral health and

pharmaceutical access—VIH maintained a body of expertise upon which community programs can draw.

Funded by the Robert Wood Johnson Foundation, VIH ceased operations in May 2005.

1 For ease of terminology we use the phrase ‘volunteer dentist’ to refer to dentists who provide their services

either for free or at greatly reduced fees.

3

MOTIVATIONS FOR VOLUNTEERING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

OVERVIEW OF THE STATE OF DENTISTRY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

BEFORE STARTING RECRUITMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

ATTRACTING VOLUNTEERS

CLINIC-PROGRAMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

REFERRAL NETWORKS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

MOBILE UNITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

SEALANT PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

RECRUITMENT METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

RETENTION METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

TIPS TO REMEMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

APPENDIX I: ADDITIONAL RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

APPENDIX II: SUGGESTED READINGS REGARDING THE PROVISION OF DENTAL CARE . . . . . . . . . . .39

Table of Contents

4

ABOUT THE AUTHORS

Gayle Goldin, M.A. is Director of Community Partnerships at Volunteers in Health Care. She holds an

M.A. in Public Policy from Tufts University. Ms. Goldin oversees Volunteers in Health Care’s technical assis-

tance services, including providing one-on-one consulting, facilitating meetings, creating manuals, imple-

menting new technical assistance strategies, and reviewing grant applications. Prior to joining VIH, Ms.

Goldin co-developed a health advocacy training program for immigrants, served as a grantwriter, and con-

ducted research on foundation funding patterns.

Sarah Hanson, M.A.T. is a consultant to Volunteers in Health Care. She received her B.A. and M.A.T in

History and Secondary Education from the University of Wisconsin - Eau Claire. She has participated in the

development of the Ohio Department of Health's web-based Safety Net Dental Clinic Manual, served as

program liaison for Reach Out: Physicians Initiative to Expand Care to Underserved Americans and

managed a state-supported health care program for the uninsured in Wisconsin.

VIH would also like to thank the two dentists and one executive director of a dental access program for

their thoughtful review of this manual.

COPYRIGHT/USAGE

Permission is granted to copy this manual. The proper citation for this manual is: Hanson SH and Goldin

GL (2002, 2004). Recruiting and Retaining Dental Volunteers: A Volunteers in Health Care Guide.

Pawtucket, RI: Volunteers in Health Care.

5

In general, dental providers volunteer for one or more of the following reasons:

■ They like the challenge of restoring

unhealthy teeth;

■ They want to draw attention to the need

for community solutions to poor oral

health (i.e., water supply fluoridation);

■ They enjoy practicing their profession and

want to share their skills beyond the tradi-

tional office setting;

■ They want to keep using clinical skills that

they might otherwise not be in a position

to use (e.g., retirees or dentists teaching

full-time);

Motivations for Volunteering

■ They see helping others as a personal or

spiritual calling. It’s “doing the right thing”;

■ They believe community service is a profes-

sional responsibility;

■ They are concerned about the lack of atten-

tion given to oral health in the health care

environment;

■ They want to make a difference within their

communities. They know that low-income

individuals with poor teeth have trouble

finding employment, have reduced self-

esteem and are less likely to enjoy full

health;

This is the backdrop for volunteering. Keep these motivations in mind as you go about recruiting or devel-

oping a recruitment plan. Make sure that your organization is responsive to these motivations and that

anyone who is recruiting for your organization understands them as well.

Overview of the State of Dentistry

While many volunteer medical models expand from providing medical services to providing dental care,

the two types of programs can be quite different. The differences lie in the nature of dentistry as a pro-

fession, the availability of dentists in any one community, and the types of services offered. The follow-

ing section offers an overview of the state of dentistry and how it may differ from using volunteers to

provide medical care to the uninsured.

1) THERE IS A DENTAL SHORTAGE.

■ There are approximately 154,000 actively

practicing dentists in the U.S. (58.4 den-

tists per 100,000)2, compared to

690,000 licensed physicians.3 The num-

ber of dentists is steadily declining due to

retirement and the decline in the number

of applications to dental schools.4 The

number of physicians, in comparison, is

increasing.

■ According to the National Access to Care

Survey, dental unmet wants in the U.S. are

greater than unmet medical and surgical

care demands.5

■ Over 1,036 areas in this country have been

designated as Dental Health Professional

Shortage Areas (DHPSA) by the federal

government.6 DHPSA designation is deter-

mined by the Health Research and Services

Administration and is based on the evalua-

tion of shortage/underservice criteria estab-

lished by regulation to qualify either geo-

graphic areas or population groups as hav-

ing a shortage of dental providers. Only 6%

of dental need is met in DHPSAs. In order

to meet this need it will take 5,000 addi-

tional dental providers to serve in these

areas.7

■ Racial and ethnic minorities are under-rep-

resented in the dental professions.8

2 U.S. Dept of Health and Human Services, Oral Health in America: A Report of the Surgeon General

(Rockville: U.S. Dept of Health and Human Services, 2000) 235

3 American Medical Association Physician Select home page retrieved 10/20/03 http://www.ama-

assn.org/aps/

4 U.S. Dept of Health and Human Services, Oral Health in America: A Report of the Surgeon General

(Rockville: U.S. Dept of Health and Human Services, 2000) 235

5 Ibid. 8

6 Ibid. 227

7 Ibid. 237

8 Ibid. 236

6

http://www.ama-assn

Because of the shortage of dentists, it is possible that in any given community there will be limited num-

bers of dentists to draw from for a volunteer dental program, and many of these may already feel over-

worked. This is particularly likely in poor or rural communities, where the low ratio of dentists to the pop-

ulation is unfathomable.9 Dentists located in Dental Health Professional Shortage Areas rarely have

enough time to meet the needs of their own patients much less volunteer or take on additional, low-

income patients. As with physicians, dentists practicing in affluent communities are likely to have fully

booked practices and may be uninterested in accepting low-income patients or patients with Medicaid.

2) DENTAL PRACTICES OPERATE DIFFERENTLY THAN MEDICAL

PRACTICES.

■ Most dentists are in solo practice (68.7%

of dentists are in solo practice, 19.6% are

in two dentist practices).10 Group practice

and managed care have not had as heavy

an impact on dental care as on medical

care.

■ Dentistry is an expensive profession that

requires a major investment in equipment,

instruments, and supplies in order to

accomplish basic procedures.

■ Overhead in a dental practice amounts to

60%-75% of practice costs.

■ Dental appointments are frequently

scheduled at 45 minutes per appoint-

ment making them considerably longer

than primary care medical appointments.

Supplies, equipment, support staff, laboratory costs and utilities make dentistry very expensive. As such,

dentists (and/or their office managers) may be very sensitive to any factors that might pinch the finan-

cial operations of a dental practice. Therefore, a dentist may view a request to volunteer outside of the

office or to take on low-income, dentally compromised patients as a severe stress on his or her practice.

3) DELIVERING DENTAL CARE IS DIFFERENT THAN DELIVERING

MEDICAL CARE.

■ Dentists require backup from hygienists

and assistants, and as such the dental

care delivered is a team effort.

■ Dental instruments vary in style and qual-

ity; dentists choose their own instruments

and become accustomed to working with

their own equipment.

Most dentists work in an environment of their own design, with their own instruments and with staff they

have personally selected. Dentists become used to and then often prefer to work with their own equip-

ment, making it difficult, for example to provide volunteer services at a different site. They are likely to be

uncomfortable or resistant to working with instruments and equipment that is not of their own choosing.

9 For example, Mississippi reports 31.3 dentists per 100,000 population and Nevada reports 32.6 den-

tists/100,000 (the national average is approximately 48.4). On the other hand, New Jersey and New York

report 65.1 and 63.3, respectively. (National Center for Health Workforce Analysis: State Health Workforce

Profiles retrieved 10/20/03 from HRSA Bureau of Health Professions

http://bhpr.hrsa.gov/healthworkforce/reports/profiles/ )

10 Id. 224 7

http://bhpr.hrsa.gov/healthworkforce/reports/profiles/

8

Because every patient is seen by more than one member of the dental team, dentistry is fundamentally a

shared experience. If dentists are volunteering in a clinic, they will be more inclined to volunteer if they

are assured there will be a hygienist and/or assistant present during the same time slot. Sometimes den-

tists feel comfortable only with their own staff and are resistant to volunteering without them, making

recruitment even more difficult. An option would be to recruit the whole team.

4) DENTISTS ARE LIKELY TO BE RESPONSIBLE FOR A BROADER RANGE

OF SERVICES THAN PHYSICIANS.

Many poor or low-income patients—even children—have never (or rarely) seen a dentist, and for most of

these patients it is unlikely that one visit will suffice. They may have extensive dental disease requiring

time-consuming and complicated treatment. The volunteer dentist may become responsible for the full

extent of that patient’s care and may be concerned about making such a commitment of time and

financial resources. This may become a dilemma of “who’s patient is it?” If the volunteer program

chooses to do so, it can create an informed consent that can limit a dentist’s responsibility. If a dental

program is located in a clinic, the dentist’s responsibility will most likely be determined by the scope-of-

service offered.

5) MANY DENTAL PROVIDERS MAY NOT BE USED TO PROVIDING CARE

TO LOW-INCOME, LINGUISTICALLY LIMITED, OR YOUNG PATIENTS.THIS UNFAMILIARITY IS A RESULT OF SEVERAL FACTORS,INCLUDING:

■ Low-income populations have a disproportion-

ate level of dental caries and tooth loss when

compared to higher income populations.

■ Low-income populations make fewer dental

visits.

■ The percentage of low-income children receiv-

ing sealants is less than in higher income fami-

lies.

■ Many low-income patients, due to financial

constraints, lack of understanding of the

importance of oral health, or shortage of

dental providers, rarely visit dental

providers.

■ Public programs (Medicaid, Child Health

Insurance Program (CHIP)) are not widely

accepted as a form of payment by

providers. Also, in many states, covered

services are primarily for children.

■ Many dentists choose not to treat chil-

dren, especially children with severe den-

tal decay and who have received only

sporadic dental care.

■ Cultural misunderstandings about oral

health and a lack of adequate interpreters,

often lead limited English speaking patients

to seek dental care only in cases of severe

emergencies.

■ Low-income populations often do not have

access to fluoridated water systems, especially

in rural areas that are dependent upon private

well water. They also have problems getting

fluoride treatments which are either unavail-

able or cost prohibitive.

9

Private practicing dentists and dental hygienists may have had little interaction with low-income patients,

and as such may make presumptions about the kind of patients they will be, including a realistic fear that

patients will not be able to keep up with their oral health. Dentists and hygienists may also be concerned

about treatment planning and modalities for these patients. It is not unusual for dental professionals who

normally provide care to insured and financially secure patients to be shocked by the extent of dental dis-

ease they find in poor or low-income patients. If they are providing volunteer services in their office,

administrative staff may assume that patients will renege on paying program fees or will be persistent no-

shows. Cultural and linguistic differences between patients and dental staff, if they exist, may compound

this problem.

Patients with extensive dental problems may need oral health education, referrals to dental specialists or

medical providers. Also, poor oral health can be an indicator of poor nutrition and medical complications.

Dentists cannot handle all of a patient’s needs and may be uncomfortable with the role of identifying and

making referrals to the necessary additional services.

One or more of these factors may affect a program’s ability to recruit oral health care providers. It is

important to understand the ‘world of dentistry’ and realize that it will take time and careful planning in

order to secure dental providers’ participation in volunteer programs.

6) DENTISTS AND DENTAL HYGIENISTS DO VOLUNTEER THEIR

SERVICES.

■ Private practicing dentists and dental

hygienists provide charitable care to low-

income patients. A 1997 survey conduct-

ed by the American Dental Association

Survey Center “Survey of Current Issues in

Dentistry” reports over 60% of respon-

dents (dentists) stated extending charitable

care to patients. (ADA1998b)

■ Volunteers in Health Care has identified

hundreds of programs across the coun-

try that use volunteer dentists and

other dental professionals.

Examples of dentists’ “good works,” whether through their own practices or organized programs, can be

found throughout the U.S. In some towns, dentists prefer to take patients into their practices with the

help of an organized referral network. In other places, dentists prefer volunteering at a clinic and using

their private offices only for specialty care. Dental vans and sealant programs offer other ways for den-

tists to volunteer their services. Whatever the model, a dental program reflects the community which

organizes it.

10

Specifically, you ought to:

1) Learn about the practice of dentistry. Explore the Internet to learn some basic dental termi-

nology. Familiarize yourself with the range of dental services available and the usual time

and cost associated with each. Talk to several dentists as well as the executive director of

your local or state dental society. Look to the resources offered by your state dental direc-

tor, dental schools and technical colleges (if available) and local public health departments.

2) Find out the number and kinds of dental professionals in your community. Know if your

community has been designated as a Dental Health Professional Shortage Area. Look at

the Bureau of Primary Care’s Web Site to find this information

http://www.bphc.hrsa.gov/bphc/database.htm

3) Learn about the extent of the dental needs of the poor and low-income population and

what services would address those needs. This will enable you to talk knowledgeably with

dentists in your community and to gauge what your program might reasonably ask of

them. Be able to talk about similar programs in other communities that look like yours.

4) Develop a profile of your proposed patient population. Accumulate information on wages,

the cost of living in your area (rent, food, utilities, etc.) and the cost of dental insurance.

Providers may be unaware that even for those workers whose employers offer dental

insurance, premiums are often prohibitively expensive. This presents a “visual” to potential

volunteers who might need convincing that low-income influences the ability to purchase

dental care and the products necessary to maintain good oral health.

■ Familiarize yourself with their professional

world. Find out what is involved in provid-

ing dental services and the “state of den-

tistry” in your community.

■ Understand the reasons why dental

providers might be reluctant to partici-

pate.

■ Anticipate these concerns, offer reasonable

options for participation that address them.

■ Gain supporters from the dental commu-

nity early in the process.

Before Starting Recruitment

There are some preliminary steps to take before starting recruitment efforts for your dental program.

These will ensure that you have laid the necessary foundation for making participation by providers as

appealing as possible. In general you should:

http://www.bphc.hrsa.gov/bphc/database.htm

11

5) Learn what assistance for dental services is available to low-income people, including

Medicaid benefits. Many times providers have a minimal understanding of dental public

benefits. Gather information on public benefits that may exist and why the population you

serve does not qualify for them or cannot access them. Familiarize yourself with other den-

tal programs, if any, that already exist in your community. Know their successes and failures.

6) As soon as you have a general understanding of the practice of dentistry and have an

understanding of your community’s dental needs, involve dentists in helping plan the

program. Be willing to learn from them. If possible, identify a “program champion” who

can serve both as advisor and advocate. Try to give these program champions a title to rec-

ognize the investment of work and personal time they will be giving to make the program

successful. It is important to find a dentist who is comfortable speaking about the project. It

is also important to find more than one dentist interested in the project, although only one

needs to serve as the public face. Peer support takes away the feeling of “doing it all your-

self.”

7) Speak to dental providers you know, such as your own dentist and hygienist. Are they

aware of the problems of access to dental care? Explain your reason for asking. Ask if your

dentist takes Medicaid, participates in Donated Dental Services or other programs for the

poor. Ask how they would view the creation or expansion of a volunteer program in their

community.

8) Find out what dental associations/societies exist in your community. Learn about the offi-

cers and general membership, their philosophy toward access issues and whether the asso-

ciation supports any initiatives designed to increase access.

9) Design your program with dental providers, or if that is not possible, find one or two dental

providers to review your program operations in detail. They will be able to tell you anything

you may have overlooked, where your presumptions may be inaccurate, what might create

a problem or resistance and whether your expectations are reasonable.

10) Address the issue of fees before you attempt to recruit dentists. This holds whether you are

asking dentists to volunteer at a clinic or to provide free or low-cost care in their office.

Many dental programs have determined they must charge some sort of fee to patients.

This is due to the cost of equipment, instruments and supplies, a desire to invest the patient

in their own care and/or an assessment that dentists will unlikely provide care for free.

Thoughtfully assess what costs (if any) your patient population can bear and talk with your

advisor dentists about the extent of fee reductions a dentist might be comfortable with.

Make sure you can clearly explain why you are or are not charging fees and how you deter-

mined the proposed fee structure. If patient fees are to be implemented, develop clear

policies for how and when they will be collected.

12

11) Be prepared to respond to questions about malpractice coverage if you are recruiting den-

tists to participate away from their usual practice locations. A survey by the American Dental

Association of “major dental professional liability insurance underwriters” revealed that chari-

ty care is covered by their policies. Coverage 1) includes legal procedures by a licensed

dentists having full time coverage, 2) contains no exclusions or limits for uncompensated

care, 3) allows care to be delivered in a variety of places (office, free clinic, dental vans, etc.)

and 4) usually contains no exclusions or limits on the type of equipment used i.e. portable

equipment used for a sealant program. The ADA cautions that any dentist interested in vol-

unteer work should check state and local laws which might possibly apply.11 Dental hygien-

ists also need insurance coverage of which the cost and requirements vary from state to

state.

Currently, states vary widely in their charitable immunity legislation and volunteers will differ

in the comfort they take in federal legislation.12 Retired dentists need to maintain a profes-

sional license and the costs of license and insurance and continuing education credits are

factors that may inhibit volunteerism. However, here too, the ADA survey of underwriters

learned that some carriers will extend a part-time policy to a retired dentist doing volunteer

work. Volunteer dental clinics and local dental societies are also able to arrange coverage in

some instances. If necessary, specify the efforts the clinic has undertaken to reduce concern

regarding this issue. Ask a dentist who volunteers at your clinic to discuss the matter openly

with potential volunteers.

If a volunteer’s insurance does not cover their volunteer activities, there are some options

organizations can pursue to find reduced cost insurance. These options are:

■ If most of the dentists at the clinic have malpractice insurance from the same carrier,

approach this company to try and negotiate a reduced rate

■ Contact your state free clinic association. Free clinic associations can provide advocacy

on behalf of member clinics, opportunities for collaborating and networking, and

resource development. They may know how other free clinics have addressed this

issue.

11 Peter M. Sfikas, “Volunteering Your Services,” Journal of the American Dental Association 130,

(February 1999): 279-280.

12 Understanding Charitable Immunity Legislation: A Volunteers in Health Care Guide summarizes

approaches states have taken in drafting charitable immunity legislation, discusses provisions of the

federal Volunteer Protection Act and captures state-specific information in a succinct table for a quick

review of legislative elements across states. Download at www.volunteersinhealthcare.org.

13

■ Check the Physician Insurers Association website

(http://www.thepiaa.org/public_home.asp) to find the physician owned insurance compa-

nies in your state. When calling ask to speak with the sales and marketing departments.

12) Racial and ethnic minorities, children and the homeless make up a significant number of low-

income and dentally uninsured patients. Develop a plan that will acclimate providers to these

populations and encourage culturally competent care. Make patient materials easy to read

and attractive. If you will be serving limited English speaking patients, consider how providers

and patients will communicate. Providers may be concerned about their ability to educate

patients or that their instructions will be misunderstood and that patients will not be able to

take care of their oral health. Contact local social service agencies and hospitals that are also

serving this population to identify potential interpreters and/or cultural trainers for providers.

http://www.thepiaa.org/public_home.asp

In the last section, we spoke in general terms about some of the steps necessary to undertake as you

plan your recruitment strategy. This section speaks in more detail to barriers that might arise within one

of the following specific types of dental programs:

Attracting Volunteers

■ Clinic-based programs in which volun-

teers provide services in their own office

■ Referral networks in which volunteers

provide services in their own office

■ Mobile units in which volunteers provide

services on a van that moves to different

locations

■ Sealant programs, in which volunteers pro-

vide sealant services for children at a site

other than their office and, in many cases, at

multiple sites.

CLINIC PROGRAMS

If your organization is seeking dental providers to volunteer at a specific site, such as a free clinic or other

facility caring for low-income patients, volunteers may have concerns about:

■ Work environment

■ Continuity of care

■ Time and scheduling

■ Personal safety of volunteers

The following sections explore these barriers in geater detail.

14

15

WORK ENVIRONMENT

Working conditions

Remember, dental volunteers want to provide quality care and to do so they must have certain working

conditions and quality equipment. Since volunteer-supported organizations often have modest budgets,

potential volunteers may be concerned that operatories may be poorly equipped or fail to meet certain

standards for care or that the facility may be an unpleasant working environment.

Try to make the clinic space look welcoming and operatories as professional-looking as possible. Make

sure that the facility can meet the power and water demands required by dental equipment. Volunteers

will want to know the state of the equipment and materials they will be expected to work with and the

availability of supplies. They will not be interested in contending with, for example, a poorly calibrated X-

ray machine or a faulty compressor. Therefore, it is critical to get the most up-to-date equipment possible

within the program’s resources. It is also important to ensure that there is a good system for inventorying

and restocking supplies on a regular basis.

Colleagues and staff

Dentists sometimes hesitate to commit to volunteer if they know they are going to be paired with staff

that they don’t know. In their own practices they traditionally work with a small staff consisting of dental

assistants and hygienists. In many instances they have worked with the same people over a long period

of time and have created a smooth, efficient team. This team is able to anticipate what the dentist needs

in order to get work completed. It is this sense of confidence that dentists will look for when practicing

somewhere other than in their own office.

Involve dentists and dental hygienists in planning the clinic and try to accommodate their

recommendations for particular pieces of equipment. Try to stock materials and instru-

ments which are commonly used, and where possible, to come as close as possible to

acquiring state-of-the-art products. If a volunteer dentist or dental hygienist is partial to a

specific instrument or material, they can be asked to bring it with them. These instruments

can be bagged, sterilized, and returned to the volunteer when they leave. Volunteers can

also be notified in advance as to the treatments they will be providing in case they want to

bring along some of their favorite instruments. Ask volunteers for feedback on their experi-

ence and for suggestions on improving efficiency or conditions. As time goes by, clinics

can add equipment and materials after evaluating their recommendations. Using different

products is sometimes considered a “perk.” Dentists have reported they like to try out dif-

ferent products without having to purchase them for their office.

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16

Sometimes dentists will be able to bring their own staff to the clinic. However, if this is not possible, give

assurances that their needs will be met if they volunteer at your clinic. For example, have the dentist meet

with the hygienist or dental assistant in advance, go over clinical procedures with the prospective volun-

teer or show how dental records are updated and maintained. Speak to the competency of both clinical

and administrative staff. Remember, dentists will be most efficient if they are working comfortably with

trained staff, using familiar instruments, and have confidence in the administration of the clinic. In addi-

tion, create an atmosphere of collegiality at your clinic. If you will be using more than one dentist at a

time, try putting dentists together who are comfortable with one another. If your clinic treats children, and

you have dentists who are uncomfortable treating pediatric cases, you may want to segregate volunteers:

children vs. adults.

CONTINUITY OF CARE

Volunteer dentists like to be assured that there is continuity of care in a dental clinic program. Questions

regarding follow-up, specialty care (if needed), after hours care and medical referrals are sure to arise. In

clinics where patients will have extractions or surgical procedures, dentists will want to know if patients will

have access to adequate emergency back-up.

New dental projects frequently start off with an all volunteer dental staff, but, as time goes by find it best

to hire a part- or full-time dentist or dental hygienist to serve as dental director who can provide consis-

tent peer support. Having a dental director who is always on-site gives dental volunteers the opportunity

to ask questions and make suggestions. Another advantage to hiring a dental director is that the director

can recruit volunteers. No matter how the clinic is administered, it is important to have a clinic document

containing all policies and procedures to ensure quality care for your patients and guidelines for your vol-

unteers.

Some projects have hired a dental assistant who takes care of the organization and

preparation of operatories. A paid or volunteer trained dental assistant is crucial to attract-

ing and retaining dentists. The assistant should also be familiar with the equipment,

instruments, and available supplies and can familiarize volunteer dentists with the clinic’s

routine. This person provides the constant, familiar presence that volunteers are likely to

be looking for. Another approach is to encourage dentists to bring their own assistants.

This can be especially effective and even allow for a dentist to keep two operatories busy.

You can also try pairing a volunteer dentist with a paid assistant and a volunteer assistant

with a paid staff dentist.

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TIME AND SCHEDULING

Many dental providers will be reluctant to volunteer for ongoing programs (as opposed to a sin-

gle day event) because of the time commitment they think is expected. Providers may have pro-

fessional obligations or expectations outside of patient care responsibilities. Some may already

be providing free or reduced fee care for low-income patients as a regular part of their practice.

Those who are most concerned with helping others may be spread thin already, devoting their

spare time to several worthy causes.

After hours care can be the responsibility of the clinic or an affiliated organization to coor-

dinate. If a clinic has paid dentists or dental director supplemented by volunteers, the staff

dentist or dental director may take on the responsibility of providing after hours care. In

other instances, after hours care is handled by clinic volunteers who are willing to see

patients in their private offices if the patients develop problems after a clinic visit. Another

method is to ask your local Emergency Department to take care of emergencies during

non-clinic hours. (Overall, it will be getting fewer indigent patients because the dental clin-

ic will be taking care of some potential emergencies.) Follow-up care is handled in much

the same way - dentists who volunteer at the clinic may agree to take patients into their

own practices or write-up treatment plans which can be followed by other volunteers.

Specialty care is often arranged as a network of dentists who are willing to take referrals

in their own offices, although some clinics have specialists come on a monthly schedule

(i.e. a monthly denture clinic). Medical conditions which are noted by dentists should be

referred to physicians with whom arrangements have made in advance.

Be as accommodating as possible, within the limits of your clinic’s operational needs.

Emphasize the clinic’s flexibility and the ability for volunteers to change their schedule (with

advance notice). Consider a limited commitment (once a month or four times a year, for

example). The length of the volunteer’s day can also be flexible (four hours or a full day,

etc.) Often, it only takes a couple of positive experiences and an organization’s appreciation

to get a volunteer “hooked.” Also, ask volunteers if there is another colleague with whom

they would like to be scheduled. This “buddy system” gives clinicians time to socialize with

colleagues they might not to get to see very often and increases the likelihood of volunteers

staying with the program.

Most importantly, make sure your clinic has a system to discourage no-shows.

Volunteers may not return if patients fail to keep appointments. Some clinics double or triple

book to guarantee a steady flow of patients; however, it’s preferable to work with patients

to keep appointments rather than run the risk of having more than one patient for a

specific time slot. Some clinics warn against overbooking, preferring instead, to require the

patient to pay a fee in advance to get an appointment. Their experience is that compliance

and self-esteem improves when there is a payment expectation. If the patient is a no-show,

the advance is forfeited.

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PERSONAL SAFETY OF VOLUNTEERS

The clinic may be located in a neighborhood perceived as a high-crime area. Real or imaginary threats to

personal safety may concern potential volunteers or their family members enough to hamper volunteer

activity. Additionally, potential volunteers may have concerns about working with patient populations (e.g.,

the homeless) whom they see as having a higher than average risk for contracting contagious diseases.

Ask a dental provider currently volunteering to speak with the potential volunteer. Or, again,

accept a limited time commitment to get the volunteer used to the clinic. You may want to

emphasize in your descriptive materials any information that counters personal safety con-

cerns and underscores the clinic’s precautions to minimize them. Health care professionals

use standard (universal) precautions so your program should be prepared with a policy and

procedure document when volunteers ask to see your exposure control plan (i.e. blood born

pathogens), hazard communication plan, medical emergency plan. In addition, the manual

should outline the program’s response to unruly patients.

Volunteers may also feel more comfortable with your patient population and the clinic’s

location once they have had a chance to see the clinic running and meet some patients.

Consider hosting an open house at your clinic to familiarize potential volunteers with the

facility, community, patients and volunteers.

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REFERRAL NETWORKS

If your organization is seeking dentists to take a certain number of patients into their practices at no

charge or at greatly reduced fees they may have concerns about:

The following section will explore these barriers in greater detail.

PATIENT RESPONSIBILITY

Inadequately screened and informed patients

Dentists may have two worries: firstly, that patients who could actually afford to pay for services will be

able to “slip through” and secondly, patients will not pay required program fees on time. A dentist who

already sees him or herself as taking on some burden to participate in the program does not want to

commit staff time to chasing down patients for monies owed.

19

Before you begin recruitment be sure the program has developed specific patient eligibility

and income verification criteria and share these standards with dentists. Also, have proce-

dures in place that will underscore the patient’s responsibilities: keeping appointments,

showing up on time, following the dentist’s treatment recommendations and paying any

fees required in a timely manner. (Some clinics actually have patients sign a “contract”

that outlines these points and states that continuing care is dependent on these conditions

being met.) Be sure that all your patient materials make clear that the dentist is either

providing the service free or at a significant discount. A dentist who is confident of the

screening procedure and patient education may be inclined to take on more patients as

the program matures.

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■ Service delivery■ Patient responsibility

20

Fear of “no shows”

Dentists will probably be concerned that patients referred as part of a free or low cost dental care pro-

gram will be more likely to miss appointments. Private practices run on an appointment system, so an

empty chair represents lost revenue. A dentist’s office may fear that it will find itself scheduling appoint-

ments for patients who do not keep them. Staff then loses the opportunity to schedule regular, paying

patients which translates to a lost opportunity for revenue. Frustration builds which can be communicated

to the dentist who, in turn, might drop out of the program.

Opening the floodgates

Dentists may be concerned that they will receive more patients than they can manage or that an organi-

zation will pressure them to take more patients than agreed upon. Even those providers who are willing

to “do their share” might have concerns that the organization will not manage patient flow in a way that

dovetails with the dentist’s own practice.

Give dentists a written statement that specifies how many patients they will see over a given

period of time (usually a “no more than” statement), what services are covered (or not) and

what the patient’s financial responsibility is to the dentist (if any). Make clear how the com-

mitment can be amended and/or terminated by the dentist or the referring organization and

make sure the agreement is revisited at regular intervals (e.g., every six or twelve months).

Include language that recognizes that providers will participate within their current practice

obligations. Make sure that the referring organization has clearly stated in writing what the

mutual responsibilities are of both the dentist and the referring organization.

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Here, the burden is on the referring organization to develop a system that includes as

many internal mechanisms as possible for ensuring that patients keep appointments.

Develop a patient reminder system such as calling patients the day before their appoint-

ment. Develop a clear organizational policy as to what the responsibility of the referring

organization will be and what the responsibility of the patient will be. Make sure both

potential providers and patients have these expectations in writing. Some programs will

even telephone providers to keep track of whether patients do keep appointments as

scheduled. It is not uncommon for a program to drop a patient who repeatedly misses

appointments. Some referral programs require patients to pay a fee in advance to get an

appointment. Their experience is that compliance and self-esteem improves when there is

a payment expectation. If the patient is a no-show, the advance is forfeited.

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SERVICE DELIVERY

Covered services

Dentists will want to know what services they are expected to provide to your program before making a

commitment. Many low-income patients have gone without seeing a dentist for years, and in some

cases they have never seen a dentist. Consequently, they may present multiple problems which have

been exacerbated by years of neglect. Dentists may be concerned that they will be asked to take

involved cases which cost their practice more time and money than they believe they can afford to give.

Be clear about services included in the program. Consider the feasibility of having patients undergo a

preliminary examination to determine the extent of needed care before being referred for services.

Lab services, supplies, and dental devices

Dentists will want to know how patients referred as part of a low-income dental program will access

lab services and dental prosthetics. Dental supplies (amalgam, sealants, etc.) can be expensive, and the

program needs to determine whether it can cover the costs of certain supplies and dental devices. The

program should investigate whether it will be able to negotiate discounted lab fees with the labs dentists

are accustomed to using or whether it will require participating dentists to use other lab providers

recruited by the program.

The need for lab services, supplies and devices will depend upon the program’s scope of

services. Negotiating discounted dental lab fees can be difficult and is not always successful.

Keep in mind that dentists may want to use their usual lab, therefore, you will need to con-

sider alternatives to negotiated discounts with just one lab. If your program and participat-

ing dentists have not been able to leverage lower fees, then you will need to decide who will

bear or share the cost. Participating dentists will want to be clear on what arrangements

have or have not been made. If applicable, make determining provision of lab services a

priority and have the information ready by the time you begin recruitment.

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As part of the planning process, and using dentists’ input, determine what services are

allowable under the program. Include specific information in your recruitment literature and

patient information. Give dentists the flexibility of deciding what services they prefer to pro-

vide. Determine whether dentists will be willing to take patients for more than one treat-

ment. Anticipate and plan for what should be done if a general dentist finds it necessary to

refer a patient to a dental specialist or a physician.

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22

Program management/coordination of services

Dentists will want to be assured and reassured that the program is able to meet its obligations to provider

participants. Providers must be confident that the program has adequate staffing, that it understands den-

tal services, that it is familiar with dental practice operations and that it will be responsive to participating

dentists. Dentists will also want to know that the project is capable of referring patients with extensive

medical needs to a volunteer physician. Additionally, dentists will be reassured to know that the program

can handle other service needs that might arise.

GETTING BUY-IN FROM OFFICE STAFF

Solo or small group practices

Dentists are the lynch pin of the practice, but the staff plays an integral part in maintaining it. Front desk

personnel are the gatekeepers and the office manager watches the “bottom line.” Sometimes a dentist

will agree to participate in your referral network and forget to inform staff. Or, a dentist might agree to

participate without involving staff in the decision making process. In other practices, the staff will have an

integral part in the decision making process. A referral program that understands and plans for these vari-

ous scenarios increases its likelihood of success.

Once dentists are recruited have a procedure for approaching their office staff about the

program. Ask recruited dentists for the names of office personnel and the best time of

day to visit with them. If the dentist can also participate in the meeting, the importance of

participation in the program will be reinforced. Personal visits by program personnel can

be very effective in educating, clarifying information and “putting a face” to the program.

The program has much to gain by developing a first hand understanding of practice loca-

tions, physical space and personnel. It will also help with provider and patient relations.

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Describe in detail how the program will operate and share with the dentist and the dental

staff all program materials. Be sure to emphasize any role that dentists played in shaping

the program and the program’s attempts to anticipate and address the potential concerns

of providers.

Make sure program staff is available to providers, including a staff member or volun-

teer to answer the phones during regular business hours. Use automated voice systems

only as a last resort. When a dentist calls, don’t be afraid to say “I don’t know, but I’ll find

out and get back to you”…and then do it. In other words…be responsive.

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Group practices

The number of group dental practices is growing slowly and accounts for only about 12% of all prac-

tices. A look in your local phone book should tell you which practices are made up of one or two den-

tists or groups. Another resource could be your local dental society. If you do identify a group practice it

is possible that the dentists are considered employees. Consequently, you may need to ask administra-

tion to grant approval to their dentists to accept patients. Another key component of a group practice

to approach might be a Board of Directors who will need to be convinced that participation is accept-

able.

Learn how the practice is governed and administrated. Ask the dentists and dental

hygienists who are developing the program to help get this information. Ask the local or

state dental society if they have it or can get it. Or, contact the practice directly and ask

who makes policy for the practice and the best way to approach them to talk about the

dental program. Decide who among your board, staff or volunteers will be the most per-

suasive to approach administration and/or the dental leadership of the practice. Having

existing business or personal ties to the practice might help get your program “through the

door.” If participation of the group practice is a key piece to making your dental program

go, make your plan carefully but also have an alternate plan in mind if the first one fails.

Be patient and persistent. Sometimes approval must be given by more than one officer,

board or department.

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MOBILE UNITS

Dental care delivered via mobile units usually take one of the following forms: the unit travels on a fixed

schedule, making stops at pre-determined sites either within a city/town or across a cluster of proximate

cities or counties; the unit travels continuously throughout the state on a fixed schedule, making stops at

pre-determined sites at selected cities/towns (staying for a few days or weeks at any given location); or

the unit travels for a limited number of weeks in the year to selected sites within a certain geographic

area.

With some mobile projects, administrators work with local organizations to identify possible volunteers in

each town. Community agencies or groups which sponsor a mobile clinic are often responsible for

recruiting local volunteers. They know their community best and can use local contacts to leverage partic-

ipation. Other projects secure volunteers willing to travel with a van or meet the van at a particular town.

In either case, organizations looking to recruit dental volunteers for mobile units undoubtedly will be con-

fronted by many or all the same concerns associated with recruiting for a clinic-based program (as dis-

cussed earlier). Providers’ concerns are likely to be heightened specifically in two areas:

Involve dentists in planning the mobile dental clinic, particularly those who have had expe-

rience in practicing from such a unit. (Sometimes dentists work on mobile units while in

dental school.) Take photographs of the unit, both inside and out to show to potential vol-

unteers. Arrange a visit to the van, if possible, so that dentists will know what to expect.

Ask dentists who have worked on these units to talk to dentists the program is looking to

recruit, to share their experiences.

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■ time and scheduling■ working conditions

WORKING CONDITIONS

Many dental providers may never have seen or visited a mobile unit and may have no idea as to

their similarity to stationary operatories. Reasonably, they may be worried about the adequacy of

the equipment, the amount of space available, the possibility of privacy and the availability of nec-

essary utilities such as electricity and water.

25

TIME AND SCHEDULING

Volunteering on a mobile unit requires a greater time commitment from dental providers than other kinds

of programs. It may be difficult to recruit dentists to travel long distances to a van site which can be par-

ticularly problematic in rural areas.

Think about any arrangements that could be made that would relieve volunteers of some the possible

stresses of making this kind of time commitment.

Try to be accommodating, within the limits of your clinic’s operational needs. Make the

van locations as convenient as possible to both patients and providers. Emphasize the

clinic’s flexibility and the ability for volunteers to change their schedule (with advance

notice). Consider a limited commitment from providers. Many vans travel to service

areas only a few times a year. The length of the volunteer’s day can also be flexible

(four hours or a full day, etc.). For this kind of program, scheduling dental colleagues

together is a particularly helpful way to recruit volunteers.

If volunteers are expected to stay overnight, determine how food and lodging are to

be provided. Volunteers in some programs pay their own way. In others, the program

covers it. Dentists and dental hygienists can be asked to either volunteer on the van or

provide emergency care for patients of record when the van is not in the area.

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SEALANT PROGRAM

Sealants offer protection from decay to the back teeth of adults and children. Consisting of a plastic resin,

sealants can be applied quickly and efficiently by dental professionals in dentists’ offices or clinics,

schools, community centers, health departments, churches, and shopping malls. Sealant programs take

place over a short time span and can be done annually. Participation in a sealant program can be a

rewarding experience for dental professionals. The time commitment is minimal and the impact far

reaching. While a sealant program needs dentists to make the diagnosis, sealants are usually applied by

hygienists. Consequently, a sealant program may require fewer dentists than other types of dental pro-

grams. Learn what regulations govern sealant application in your state. If your organization is seeking den-

tists and/or dental hygienists to volunteer in a sealant program they may be concerned particularly about

WORK CONDITIONS

As sealant programs can take many forms, volunteers will want to know the conditions under which they

are being asked to provide services. Where will services be delivered—e.g., within a school, a dental van,

a health department, a technical college, a community clinic or private practice? Will the program use

portable equipment which can transform community sites into dental clinics?


■ time and scheduling

Learn about sealant programs and any state regulations on the application of sealants.

There are many examples of successful sealant programs from around the country that

can be used to support the purpose and methods you choose. If you involve dentists,

hygienists and assistants from the very beginning in planning your sealant program, you

will be able to anticipate the questions of potential volunteers. Approach local dental

associations to get their endorsement of your program. Be sure volunteers are made

aware of the partners possibly involved in creating your sealant program - local and state

health departments, public schools, schools of dentistry and dental hygiene and a wide

array of community organizations.

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■ work conditions

■ covered services

27

COVERED SERVICES

Not all dentists include pediatric care in their practices. If you are asking these dentists to volunteer

they may be apprehensive about screening children. Be sure that you have an accepted protocol for

dentists to follow. Be clear as to whether dentists will be both conducting screenings and applying

sealants. Dentists may also be concerned with continuity of care. Have a procedure in place for

referring children with dental needs requiring follow-up.

Try to identify dentists in the community who see pediatric patients and/or have participat-

ed in sealant programs in the past - either in your community, other communities or as

part of their dental school experience. Ask if they can help explain the value and methods

of a sealant program to potential volunteers. General dentists who see pediatric patients

as well as pediatric dental specialists in your community can be asked to help develop ori-

entation materials for volunteers. These same dentists may also be willing to participate

in the program by screening children or by accepting referrals from dentists who are

screening.

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Some sealant projects have dentists bring their staff to participate, too, which turns out to

be a morale builder for the practice. Successful sealant programs have found that it is

important to be flexible when scheduling volunteers. Ask what times are best for them -

perhaps mornings or afternoons of days off. Sealant programs not tied to the school day

can be offered as volunteer opportunities on evenings, weekends and school vacation

times. Remember to factor in travel time and program site location when asking for vol-

unteers especially if you are considering evening hours.

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TIME AND SCHEDULING

Dental professionals may be concerned that the schedule for a sealant program, if held during the

school day, will conflict with their usual practice routine.

28

All programs that depend extensively on volunteer efforts require a long-range recruitment plan in order

to ensure ongoing availability of necessary volunteers. When top community leaders are convinced of the

worth of a particular program or service, it can result in support, resources, and assistance from the top

down throughout the community. When dental care providers see that the whole community is involved,

they may be more willing to participate themselves.

The most common ways organizations recruit volunteers include:

PERSONAL INVITATION

The most effective way to recruit dental care providers, and dentists in particular, is for a current

dental professional volunteer to speak directly to a potential volunteer. The personal invitation

method can take various forms, although it works best when the provider doing the recruitment is known

and respected by the potential volunteer. A few variations on this approach are presented here:

The community leader approach

Quite often in a volunteer-supported dental program, the clinic dental director, board president, or board

members are dental professionals known or respected by others. Their personal requests for assistance

are not easily refused by individuals or groups like professional associations. Some programs have found

that a little peer pressure (“everyone else is doing it except you”) is effective.

The friend and co-worker approach

An enthusiastic volunteer who can say to other providers, “Come and see what we do” or “Come and

give us a hand” can very effectively recruit co-workers, friends, and dental providers new to the local com-

munity. Encourage volunteers to share their job descriptions and experiences, to bring peers into the a

fixed or mobile clinic, to encourage potential volunteers to speak with clinic staff directly or to report their

colleague’s interest in volunteering to clinic staff for follow-up.

The cross-professional approach

Usually, dentists are best recruited by other dentists. They will be much more responsive when a group

of their peers requests their help in treating indigent patients; however, sometimes dental assistants, den-

tal hygienists and physicians have been instrumental in recruiting them into the program. Because of the

complex concerns dental professionals may have, many projects have found that lay-people are often

times the least effective recruiters.

Recruitment Methods

29

The organization approach

It is helpful to develop relationships with the local dental society, hospital(s) and other professional and

business associations. Routinely making presentations at their meetings is a method of enlisting their

support. Think big and ask for help. For instance, societies have given “committee” status to a volunteer

clinic or van, thereby ensuring presentations at society meetings. Some local dental societies also may be

willing to recruit new dentists for volunteer efforts and recognize them by identifying members who vol-

unteer with a special marking in their directory listing or in their newsletter.

The patient or lay volunteer approach

There are instances where a person associated with the dental program has successfully recruited their

own dentist or dental hygienist to volunteer. While this method is sporadic and not very effective, it is

important for all of your volunteers and patients to know what to do if they encounter a potential volun-

teer. Make recruitment hand-outs or the volunteer coordinator’s business cards readily available.

Develop a protocol for these types of volunteer referrals (for instance, sending a thank you note to the

referring patient/lay volunteer).

PRESENTATIONS AND EVENTS

Effective recruitment tactics include personal presentations to diverse community groups and professional

societies. Meetings with individual dentists or group practices to provide information about services and

to discuss personnel needs may also be effective. Some programs utilize a short video to show potential

volunteers how it works.

Well-planned recruitment events are effective ways to attract volunteers. In some cases a dentist who

already has a relationship with a program has hosted a dinner for dentists in the area. This gave an

opportunity for dentists to learn about the program and ask questions. Fixed clinics and vans have host-

ed open houses. Dentists can tour the facility and ask questions of the staff. Media coverage can be

arranged for an open house so that the public learns of the program, too. Be aware of the potential

recruitment value of every activity. Consider establishing a volunteer recruitment position in your pro-

gram, even if this position itself is filled by a volunteer.

APPEAL/INVITATION LETTERS

Some programs have reported success by sending out appeal or invitation letters as a blanket request to

all licensed dentists in an area. Other programs target providers new to the area or newly retired dentists.

Identification of newcomers and new retirees may be available through dental society lists or by checking

newspapers for announcements. Dental and dental hygiene societies, and other professional associa-

tions, also have member lists of potential volunteers. The Board of Licensure for each state keeps infor-

mation on dentists licensed in that state. A few programs have successfully recruited dental volunteers

by placing requests in professional journals and newsletters, and newspaper advertisements.

30

MEDIA COVERAGE

Local television features, radio interviews, coverage of fund-raising activities, and PSAs (public service

announcements) increase exposure to clients, benefactors, and potential volunteers while giving validity

and credibility to the organization. In general, media coverage may do much to increase awareness of

the needs of the uninsured, but seems to have minor effects on recruitment of volunteers.

COMBINING STRATEGIES

One-on-one solicitation is often the most successful, and easiest, way to recruit or increase the num-

ber of volunteers for your organization. Yet, by combining strategies through media coverage, letters, and

recruitment events an organization can not only expand opportunities for recruitment, but also greatly

increase the community’s awareness of the needs of the uninsured locally.

31

Recruiting and training volunteers is only one part of the process of operating a volunteer-based service.

It is equally important to plan ahead in order to put in place effective methods of retaining those volun-

teers already working. Without proper organization, recognition, and encouragement, it is difficult to retain

volunteers over a sustained period of time.

The following lists some techniques that can be used for retaining dental volunteers:

MAINTAINING A WINNING OPERATION

A smooth-running, well-prepared work environment helps to keep volunteer providers’ work simple and

consistent. Well-maintained records, adequate supplies, and functioning equipment demonstrate to vol-

unteers that the organization is there to support what they do. Make sure your system for handling com-

plaints and questions is clear to all.

For programs operating referral networks where providers see patients in their offices, the key is to create

and maintain well functioning administrative systems that can accurately capture, track and report out

referral information.

For fixed and mobile clinics, creating a dental director position with staff assistance from someone trained

as a dental assistant or hygienist will help ensure that the program operates efficiently. Programs also

benefit from someone on staff to provide quality assurance and case management for patient follow-up.

This reassures dentists that the patients they treat will continue to get quality care.

Sealant programs need an administrative system which will smoothly coordinate community partners, chil-

dren and volunteers.

Verifying academic credentials and licensure, or the act of credentialing volunteers, is also a very impor-

tant component of running a volunteer based program. Do not assume the volunteer dentist is licensed,

especially if they do not have their own office. Credentialing volunteers builds trust among participating

clinicians, reassures program staff and board members, and helps ensure the quality of care your patients

will receive. It is also important to periodically check volunteers current insurance coverage. Sometimes, a

dental society or other eligible entity will assist a program in the credentialing process.

Cultivate relationships among volunteers in one setting or locale. Have regular meetings to share infor-

mation, to relate experiences frankly and openly and to develop creative solutions to the problems.

Retention Methods

32

SCHEDULING

Scheduling may be as simple as having volunteers sign up a month in advance with a few quick phone

calls to fill in the gaps in the schedule as needed, depending on the size of the volunteer effort. Larger

volunteer operations may require coordination of hundreds of volunteers with scheduling done as much

as a year in advance.

Scheduling works best when done as far in advance as possible, while simultaneously maintaining some

flexibility for last minute changes. Send volunteers a copy of the appointment schedule to check the time

allotted. Make reminder calls prior to times when volunteers are scheduled to work. Schedule hours in

the evening to accommodate volunteers who are often unavailable during the day.

To prevent burnout and drop out of volunteers, schedule individuals at intervals. Ideal coverage involves

many individuals working less frequently. When volunteers are working, schedule patients to keep volun-

teers busy but not overloaded. Honor requests for schedule amendments and specific numbers of

patients. Volunteers should always work at their own comfort level. Specialists asked to provide general

dentistry might appreciate being scheduled to work with the dental director or a general dentist so that

they may consult with them if desired.

MAINTAINING ATMOSPHERE

Maintaining a warm, informal, welcoming atmosphere is important to retaining volunteers. Take care of

volunteers by providing them with snacks and time to socialize and to provide balance with the work.

DEVELOPING CAMARADERIE AND COMMUNITY

A special spirit often develops among volunteers. Often while working together towards common goals,

volunteers pool their talents and develop cohesive work teams. Bonds of friendship form which may

occasionally extend outside the work setting. Providers experience an important sense of belonging. This

sense of community is critical in retaining volunteers.

Several mechanisms may be used to support camaraderie in staff. Send holiday or birthday cards to vol-

unteers. Arrange one or two gatherings a year to celebrate, share and help volunteers integrate their

experiences while giving them a chance to meet others who may work on different schedules. Tell suc-

cess stories. Create a newsletter to keep volunteers informed of changes in operations, personnel, and

available resources. It can highlight new activities and special interest stories about patients, and promote

a community spirit through regular communication.

33

ESTABLISHING PROGRAM OWNERSHIP

Getting dental volunteers involved in ways other than direct care strengthens their commitment to the

effort. Some programs have found that volunteers are the best donors! Solicit their opinions for

improvement and use their suggestions. Offer them opportunities to serve on boards, task forces, com-

mittees and assist with special events (i.e golf tournament). For example, you might develop a volunteer

dental advisory board to deal with reviewing protocols or provide consultation for complicated cases.

These help to establish further ownership and commitment to the operation.

Remind volunteers that “It couldn’t be done without you.” They must understand that their continued

assistance is vital to the effort, that they play a critical role, and that they would be missed if they were

not there. It is important to understand a provider’s motivation to volunteer and then to give them expe-

riences which meet their expectations and make them feel their time is well spent. They come back

because they see that they are needed. Usually, the quality of the program that first attracted a dental

professional is the retention instrument that keeps him or her there.

Remember to thank volunteers each time they help out. A personal note of thanks after completion of

particularly difficult or lengthy service acknowledges special efforts and is appreciated by volunteers.

Thank you notes can also go out during Volunteer Week and holiday time. Including a photo of a volun-

teer’s day at the clinic is an additional way to express appreciation.

REMINDING VOLUNTEERS THEY HAVE AN IMPACT

Nothing is more rewarding to dental care providers than seeing patients’ dental health improve. Patients’

sincere expressions of appreciation touch the heart and are a continuous source of satisfaction for volun-

teers. Encourage patients to send “thank-you” notes to volunteers who have cared for them.

Share information about successes including numbers of people served, dollar value of services provided,

and stories of successful patient outcomes. This information also works well for speakers and to help

with fundraising.

RECOGNITION

Try to assess the kind of recognition that your volunteers might most appreciate. In one community, vol-

unteers are recognized at an annual luncheon sponsored by the Department of Health’s Volunteer

Services Program. Some volunteers do not want money spent on formal efforts of appreciation and say

they prefer to work quietly and to receive recognition in other ways, such as certificates, plaques, token

gifts or “Thank you” ads in local newspapers. Other ways to make volunteers feel appreciated include

making nominations for existing award programs (e.g. state dental association awards), sending written

thank you notes, and recognizing volunteers at local dental society meeting and/or in society newsletters.

Be creative. One clinic recognizes volunteers by taking instant Polaroid pictures of volunteers and display-

ing them on a centrally located bulletin board. As one director put it “The best way to recognize a contri-

bution continues to be one-on-one!”

34

Remember, recognizing your volunteers also gives you an opportunity to promote your organization and

recruit new volunteers. Be sure to send press releases to dental and dental hygiene schools, societies,

and the local media to announce your recognition events. Additionally, nominate (or have patients nomi-

nate) volunteers for local and national service awards.

35

AND REMEMBER…■ Periodically review how satisfied you have been with the efficiency, quantity and quality of

your volunteers and how satisfied they are with their experiences.

■ Consider creating the position of volunteer coordinator to oversee and encourage recruiting

volunteers.

■ Develop a selection plan with emphasis on matching each volunteer’s desires, expertise and

time commitment with the needs of the organization.

■ Clearly define the ways in which volunteers could play roles in your organization other than

direct care; make opportunities available for volunteers to serve on your board or consider

using committees below the board level to actively involve more volunteers.

■ Create materials, such as a volunteer handbook, that clearly state the program’s goals, volun-

teer’s responsibilities, and the method for providing feedback to the program staff

■ Establish some routine way of recognizing volunteer service.

Tips to Remember

36

ADDITIONAL RESOURCES

DENTAL PROGRAM RESOURCE MATERIALS

■ Filling the Gap: Strategies for Improving Oral Health Issue Brief #10

Grantmakers in Health

http://www.gih.org/info-url2678/info-url_list.htm?attrib_id=3324

■ From the American Dental Association’s (ADA) Council on Access, Prevention and

Interprofessional Relations (CAPIR):

– Obtaining Funding for Dental Access Programs: An Overview (2001, 55 pages)

– Dental Access Program Marketing: How to Build Public Image and Participation (2001,

54 pages)

– Manual on Dental Care Access Programs (2000, 108 pages)

These ADA resources can link program managers to useful information and facilitate adminis-

trative responsibilities. All three documents are available for a nominal charge ($10 for ADA

members and $15 for non-members, plus tax where applicable) by calling CAPIR at (312)

440-2673 or by e-mailing [email protected].

■ Safety Net Dental Clinic Manual

Ohio Department of Health, Indian Health Service and The Association of State and Territorial

Dental Directors

http://www.dentalclinicmanual.com/

■ Sealant Program Guide

Healthy Smiles for Wisconsin, Seal a Smile Initiative. This site contains a downloadable planning

guide and portfolio including A-Z information on planning and implementing a sealant program.

http://www.healthysmilesforwi.org/

DATA SOURCES

■ Centers for Disease Control

Cooperative Agreements to Strengthen State Oral Disease Programs, March 2003

http://www.cdc.gov/OralHealth/pressreleases/co-op.htm or

http://www.cdc.gov/OralHealth/state_reports/cooperative_agreements/index.htm

■ Fedstats (US Federal Interagency Council on Statistical Policy), Offers a full range of statistics

and information produced by 70 agencies for public use

http://www.fedstats.gov

Appendix I

http://www.gih.org/info-url2678/info-url_list.htm?attrib_id=3324

http://www.dentalclinicmanual.com/

http://www.healthysmilesforwi.org/

http://www.cdc.gov/OralHealth/pressreleases/co-op.htm

http://www.cdc.gov/OralHealth/state_reports/cooperative_agreements/index.htm

http://www.fedstats.gov

37

■ U.S. Dept. of Health and Human Services

Health Resources and Services Administration

– State Profiles

http://www.hrsa.gov/profiles.htm

– HPSA designations (including "dental"). This site can refine a search down to the

county level which then includes census tracts

http://bphc.hrsa.gov/bphc/database.htm

GOVERNMENT RELATED DENTAL SITES

■ Association of State and Territorial Dental Directors

http://astdd.org

■ Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Oral Health Resources

http://www.cdc.gov/OralHealth/index.htm

■ National Conference of State Legislatures

http://www.ncsl.org/programs/health/oralhea.htm

■ National Institute of Dental and Craniofacial Research

http://www.nidcr.nih.gov/

■ National Maternal and Child Health Oral Health Resource Center

http://www.mchoralhealth.org/

■ National Oral Health Clearinghouse

http://www.nohic.nidcr.nih.gov/

DENTAL RELATED PROFESSIONAL ORGANIZATIONS

■ Academy of General Dentistry

http://www.agd.org/about/index.html

■ American Academy of Pediatric Dentistry

http://aap.org

■ American Dental Association

(contains a comprehensive list of links to dental associations, organizations, schools)

http://ada.org

■ American Dental Education Association

(formerly the American Association of Dental Schools)

http://www.adea.org/

http://www.hrsa.gov/profiles.htm

http://bphc.hrsa.gov/bphc/database.htm

http://astdd.org

http://www.cdc.gov/OralHealth/index.htm

http://www.ncsl.org/programs/health/oralhea.htm

http://www.nidcr.nih.gov/

http://www.mchoralhealth.org/

http://www.nohic.nidcr.nih.gov/

http://www.agd.org/about/index.html

http://aap.org

http://ada.org

http://www.adea.org/

38

■ American Dental Hygienists Association

http://adha.org

■ The American Dietetic Association

http://www.eatright.org/Public/

GENERAL INTEREST

■ Oral Health America

An independent, non-profit national charity that works to educate the public, improve access to

services, and support research and dental education

http://www.oralhealthamerica.org

■ The Children’s Dental Health Project

http://www.cdhp.org/

■ The Virtual Dental Center

http://www.martindalecenter.com/Dental.html

SUGGESTED READINGS

■ A Medicaid Population’s Use of Physicians’ Offices for Dental Problems, Cohen et al. Am J

Public Health.2003; 93: 1297-1301.

(http://www.ajph.org/)

■ Centers for Disease Control Surveillance for Use of Preventive Health-Care Services by

Older Adults, 1995-1997

http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/ss4808a4.htm

■ Dental Care Utilization: How Saturated is the Patient Market?, Brown, L. J. and Lazar, V. The

Journal of the American Dental Association., 1999 April; 130: 573-580.

■ Keep America Smiling: 2003 Oral Health Report Card

http://www.oralhealthamerica.org/Report%20Card.htm

■ "Oral Health: Dental Disease Is A Chronic Problem Among Low-Income Populations,”

Government Accounting Office April, 2000. GAO Report # HEHS-00-72 The first copy of each

GAO Report is free to order by phone call (202) 512-6000

■ "Pediatric Dental Care in CHIP and Medicaid: Paying for What Kids Need Getting Value for

State Payments,” Colmers, John; Fox, Daniel M.; Praeger, Sandy, and Rawson, Raymond D.

Milbank Memorial Fund, (212) 355-8400

■ The Growing Challenge of Providing Oral Health Care Services to All Americans, Health

Affairs Sept/Oct 2002

http://www.healthaffairs.org/1130_abstract_c.php?ID=/usr/local/apache/sites/healthaffairs.org/h

tdocs/Library/v21n5/s11.pdf

■ U.S. Department of Health and Human Services "Oral Health in America: A Report of the

Surgeon General" Rockville MD

http://www.surgeongeneral.gov/library/oralhealth/

http://adha.org

http://www.eatright.org/Public/

http://www.oralhealthamerica.org

http://www.cdhp.org/

http://www.martindalecenter.com/Dental.html

http://www.ajph.org/

http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/ss4808a4.htm

http://www.oralhealthamerica.org/Report%20Card.htm

http://www.healthaffairs.org/1130_abstract_c.php?ID=/usr/local/apache/sites/healthaffairs.org/h

http://www.surgeongeneral.gov/library/oralhealth/

39

SUGGESTED READING REGARDING THE PROVISION OFDENTAL CARE

■ A Community Collaboration: The Dental Emergency Assistance Program, Watson, M. L.;

Trompeter, K. M.; Lang, P. L.; Allen, D.; Misfud, J., and McGowan, J. M. The Journal of the

American Dental Association, 1996 August; 127: 1240-1246.

■ Addressing Oral Health Needs: A How to Guide, revised and expanded 2002

http://www.communitycatalyst.org/acrobat/Dental_How_To_Guide.pdf

■ Children’s Oral Health: State Initiatives and Opportunities to Address the Silent Epidemic,

http://www.astho.org/pubs/childrenoral.pdf

■ Community Roots for Oral Health: Guidelines for Successful Coalitions

http://www.doh.wa.gov/cfh/OralHealth/manuals/Roots/Roots.html

■ Improving Oral Health Care in Rural Areas, McCunniff, Michael D., The Rural Clinician

Quarterly (The Clinician Newsletter of the National Rural Health Association), Spring 2000:

Volume 10, No.2.

■ Oral Health U.S., 2002 http://drc.nidcr.nih.gov/report.htm

■ The Great Dental Giveaway, an editorial. The Journal of the American Dental Association,

1999 February; 130: 154-156.

■ U.S. Department of Health and Human Services. National Call to Action to Promote Oral

Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service,

National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH

Publication No. 03-5303, Spring 2003 http://www.nidcr.nih.gov/sgr/nationalcalltoaction.htm

■ Volunteering Your Services, Skifas, P.M. The Journal of the American Dental Association, 1999

February; 130: 278-280.

Appendix II

http://www.communitycatalyst.org/acrobat/Dental_How_To_Guide.pdf

http://www.astho.org/pubs/childrenoral.pdf

http://www.doh.wa.gov/cfh/OralHealth/manuals/Roots/Roots.html

http://drc.nidcr.nih.gov/report.htm

http://www.nidcr.nih.gov/sgr/nationalcalltoaction.htm

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