All of the people in
these scenarios are experiencing frustration
with lack of resources or situations they
perceive as insurmountable. Most of these
situations cannot be solved by individuals
but require collaborative efforts, communication,
advocacy, and changes in systems.
It does take at least one passionate and
committed individual, however, to start
needs assessment process can foster
constituency building and collaborative
Potential Barriers to Oral Health and Dental
What oral health issues create challenges
or frustrations in your community? Use the self-assessment
tool-- a worksheet with examples of potential barriers,
with space for you to add additional ones specific to your
community. Perceptions of issues and potential barriers may
differ among parents, health professionals, public health
staff, the business community, and other groups. Or there
may be differences based on ethnicity, socioeconomic status,
age or gender. Where is your community in the process of identifying,
prioritizing and addressing the issues outlined in the self-assessment?
is important to assess the range
of perceptions in a community,
not just listen to one group or
the most vocal people. This allows
analysis of commonalities, differences
and reasons for the perceptions.
Various methods can be used to get
input from a variety of individuals or groups. Surveys,
SWOT analysis, and
are a few methods that have been used successfully. An overview
of needs assessment methods is provided that compares
purpose, cost, time involved and advantages. Sometimes a neutral
person who is not a member of the community can collect and
analyze people's perceptions in an objective way. On the other
hand, trusted and respected members of the community may be
able to elicit more meaningful information After opinions
have been documented, the focus of the analysis and presentation
of information should be an acknowledgment that there are
differences of opinion but everyone's opinion is of equal
on commonalities rather than differences
will help move people forward
also includes collection and analysis of data,
e.g., numbers of children who have dental
decay and are not receiving care, or the number
of dentists who are enrolled as providers
in the Denti-Cal program. It is important
to validate the perceptions you have gathered
with actual facts so you can discuss the issues
using qualitative and quantitative information.
This can be accomplished through secondary
data collection (locating and summarizing
existing data from various sources), or primary
data collection (collecting new data). A number
of resources are available to help you do
both. An excellent "how to" manual is Assessing
Oral Health Needs: ASTDD Seven Step Model,
available to view or download and print at
(click on publications).
One of the worksheets
in the Seven Step Model asks you to look at
your goals for doing a needs assessment.
example, do you want to:
- establish baseline data?
- update existing data?
- document the extent of oral health needs
in a community or subgroup?
- show the gaps in services?
- demonstrate the need for more service
- demonstrate the need for collaboration
and coordination of efforts?
- show the changing demographics of the
One of the keys to collecting data and information
is to be clear on your goals. Spend time collecting
the information you need, not extraneous information
that is "nice to know" but won't be useful
for documenting your needs. Needs assessment
information also serves as a baseline for
evaluating your outcomes.
a Statement of Need
Once you've collected and analyzed the
information, the next step is using it
to address the identified problems.
a concise, compelling description
of the major oral health issues
in a community is a crucial step
for enlisting partners and resources
to address the problems. A common
mistake is to know that problems
exist but not be able to document
their importance to decision makers
or funders who could help provide
resources and solutions. When
writing a "statement of need",
don't make the situation appear
hopeless-it needs to appear challenging,
but not insurmountable.
Compare the following
three ways to make a point in a statement
The mean dfs for Head Start children
ages 3-5 in rural areas is 4.5.
Prevalence of early childhood
caries is 40% of 5-year-olds.
Treatment costs range from $400
By the time they reach age 5,
40% of Head Start children in
rural areas will have dental decay.
Treatment for severe cases can
cost almost $4,000 per child if
hospital anesthesia procedures
a photo of a child being treated
in the hospital, with caption
of "Up to 40% of 5-year-old Head
Start children in rural areas
may incur costs of $4000 each
to treat their dental decay."
When writing a statement of need, consider
the audience. The first statement is written
with epidemiologists and oral health researchers
in mind as part of a research application
or journal article. Statement 2 is more
appropriate for a grant application. Option
3 is useful for newspaper or other advocacy
pieces where you want to create a memorable
visual image and an emotional response.
Important elements to consider in presenting
information include the literacy level
of the audience, their potential interest
in the topic, and knowledge of oral health
issues. Your goals for writing the statement
of need will determine what information
View an example of a statement
of need. Note--some funders expect you to include a description
of your proposed solutions in the Statement of Need section
of a grant proposal, while others request that type of information
in a Proposed Methods section.
Once you have identified
issues and potential barriers-"defined
the problem"--you will need to step back
and prioritize which ones you can realistically
tackle, and what strategies you will use.
Ask these questions:
- What do you really want
- What can you accomplish
in the immediate future, versus a year
from now or in five years?
- What are the community's
- Who can help you make
your ideas a reality?
- What resources will
- How can you mobilize
people to rally around the cause?
- Do you have people in
the community with the knowledge and skills
that are needed, or will you have to look
for help from experts or other communities?
- Are other communities
having similar problems?
- Would it be beneficial
to join with other communities to leverage
These are important
questions to ask when planning an effort
to improve the oral health of a population.
Chapter 2 addresses ways to mobilize community
assets for collaborative planning. A variety
of planning and evaluation models are
available to help you develop goals, objectives,
activities, and desired outcomes.
become frustrated with the planning
process and jump right into solutions.
It will cost you time, money and
more frustration if the solutions
are not appropriate or if you
can't mobilize the needed resources.
Take the time to create a vision
of what you want to do, who can
help you, and the paths you can
take to accomplish your goals.
Healthy People in Healthy
Communities, a booklet available on the
Healthy People website at http://www.health.gov/healthypeople
uses a MAP-IT approach to planning that
is based on achieving Healthy People 2010
objectives for the nation. MAP-IT stands
individuals and organizations
that care about the health of
community into a coalition.
the areas of greatest need
in your community, as well
as the resources
and other strengths that you
can tap into to address those
your approach: start with
a vision of where you want
to be as a
community; then add strategies
and action steps to help you
achieve that vision.
your plan using concrete action
steps that can be monitored
make a difference.
your progress over time.
and organizations that care about the
health of your community into a coalition.
Assess the areas of greatest need in your
community, as well as the resources and
other strengths that you can tap into
to address those areas. Plan your approach:
start with a vision of where you want
to be as a community; then add strategies
and action steps to help you achieve that
vision. Implement your plan using concrete
action steps that can be monitored and
will make a difference. Track your progress
A similar approach called MAPP (Mobilizing
for Action through Planning and Partnerships), promoted by
the National Association of County and City Health Officials
(NACCHO), is available at http://www.naccho.org.
Nine communities/counties are implementing the MAPP process
to show how it can be used in a variety of settings:
- Amherst, MA
- Hartford, CN
- Columbus, OH
- Lee County, FL
- Mendocino, CA
- Nashville/Davidson County,
- Northern Kentucky District,
- San Antonio, TX
- Taney County, MO.
Federal agencies and many foundations
use "logic models" to assist in the planning and evaluation
process. Logic models link program resources and activities
to program products and outcomes, while communicating the
logic and rationales behind the program. Faulty logic can
lead to ineffective and inefficient programs. United Way uses
logic models that are focused on local communities. Some of
the county First 5 Commissions in California use this model
for writing their requests for proposals. See the Resources
section of this chapter for websites and references on logic
models or similar planning models. View a logic
model related to oral health.
Options for Solutions
A number of national and state conferences
have addressed oral health issues and
barriers to dental care; some have specifically
addressed rural issues. Electronic versions
of reports from some of these meetings
can be viewed at http://www.mchoralhealth.org
(look under state or regional reports.)
They might provide ideas for ways to assess
and address specific problems.
The Children's Dental Health Project has
summarized problems experienced by 15
states as well as some potential strategies
to address dental access problems (http://www.cdhp.org
look under state surveys of oral health
UCSF Center for the Health Professions
published a report, Improving Oral Health
Care Systems in California (http://futurehealth.ucsf.edu/dentalaccess.html),
funded by the California Healthcare Foundation.
Chapter 3 highlights some of the barriers,
disparities, and factors influencing the
probability of persons seeking dental
View an overview table of some strategies
to reduce five different types of barriers. Some of the
columns have been left blank to enable use as a worksheet.
The next few chapters of this manual provide descriptions
and examples of specific strategies to use for various problems.
chapter has prompted you to ask the following
- What oral health issues create
challenges or frustrations for your community?
- Have a variety of people been asked
to voice their opinions and concerns to
gain a broad perspective on the issues?
- Have the issues been analyzed? How?
- Are there data to document the problems?
- Has the community identified its strengths/assets/resources?
- Has all of this information been developed
into a statement of need?
- Have broad goals and strategies been discussed?
- Has a comprehensive planning process been
designed to address the oral health issues?
Community Catalyst, Inc. A Guide to Organizing
Community Forums. July 2002. http://www.communitycatalyst.org.
Gamm LD et al, eds. The state of rural
oral health. (In Rural Healthy People 2010:
A Companion Guide to Healthy People 2010.
Vols 1 and 2, 2003. http://www.srph.tamushsc.edu/rhp2010/.
Lees DH. Operational application of a county
wide oral health needs assessment. Abstract.
J Public Health Dent. 63(Suppl 1):547, 2003.
State of Washington Department of Health.
Community Roots for Oral Health: Guidelines
for Successful Coalitions. Olympia, WA,
2000.l Also includes the following Appendix
under Evaluation. Selecting and Evaluating
Outcomes for Oral Health Coalition Efforts.
United Way of America. Measuring Program Outcomes:
A Practical Approach. Alexandria, VA, 1996.
(To order, call Sales Service/America, 800-772-0008,
item # 0989.)
for help in designing a simple logic model
for a prevention program.
A more detailed description of logic models
with checklists and examples is available
through the WK Kellogg Foundation website
What did you learn or accomplish as a result
of reading this chapter? Did it help you
to organize your thoughts about oral health
issues in your community? Are you planning
a community needs assessment or already
writing a statement of need? Were the
resources and examples helpful? Complete the feedback form for Chapter 1 to tell
us what was useful and not useful for