Step 1: Preparation

Find and Establish Community Partnerships

By the end of this step, programs should aim to have:

identified potential partners
clarified shared goals
outlined partner roles and responsibilities
begun developing referral and communication pathways
determined whether an MOU, contract, or other formal agreement is needed
identified how the program will track progress and make improvements over time

The first step in developing a school-linked dental program is preparation. This includes identifying partners, available resources, shared goals, and quality improvement processes needed to support planning, implementation, and long-term sustainability. Early partner engagement helps programs align services with student and family needs, reduce duplication of efforts, strengthen referral pathways, and build a shared approach to tracking progress and improving the program over time.

Potential community partners are community organizations, groups, and/or agencies that are currently engaged in or have the expertise to contribute towards the focus area of the intended program, such as those involved in children’s equity efforts, children’s health, children’s oral health, or family healthcare services.

Partnerships can begin small and expand over time. Programs may start with one school, one grade level, one referral partner, or one priority activity, then build additional partnerships as needs, capacity, and resources become clearer.

Steps to an Effective Collaboration

Define the level of integration

Involvement of partners among organizations and agencies varies over a spectrum of integration. The level of integration should be determined at the level of the desired task. Specific program tasks may require limited integration where partners cooperate to share resources and information. Whereas tasks involving services, activities, and co-sponsorships, such as care coordination or case management, require greater integration and coordination among partners for mutually beneficial outcomes.

Establish working norms

Collaborating partners work together to strategize the action plan based on SMART+C objectives (i.e., specific, measurable, achievable, relevant, timed, and challenging). The partnership is formalized through a memorandum of understanding (MOU) or contracts. The partners agree upon a timeline, roles, and responsibilities of all involved, a communication strategy, resources needed, and an evaluation plan. Successful collaborations are built on trust and respect and, more essentially, understanding limitations and preparing for conflicts. The planning discussions should include identifying a strategy to mitigate and resolve conflicts.

Further details on the process of developing successful partnerships can be obtained from ASTDD Handbook on Planning, Evaluating, and Improving Collaboration for Oral Health Programs and the Campus-Community Partnerships: Steps to Building a Collaborative Partnership.

Partners to Facilitate a School-Linked Oral Health Program

When identifying partners, consider organizations and individuals who understand the needs, strengths, languages, and cultural contexts of the priority student population. Including partners who work directly with students and families can help ensure the program is responsive to community needs and addresses barriers to accessing preventive dental care.

Partner type	Possible role in a school-linked dental program
Schools, districts, and COEs	Support program planning, student access, family communication, scheduling, and coordination with school staff
School nurses or health coordinators	Help identify student needs, support education, coordinate referrals, and communicate with families
Dental providers and FQHCs	Provide screenings, preventive services, referral pathways, or dental homes
Community-based organizations	Support outreach, family engagement, language access, and connection to social supports
Public health programs	Coordinate resources, oral health education, data, quality improvement, and program sustainability
Professional schools or associations	Support workforce development, volunteers, education, and referral networks

School boards and administrators

A strong partnership with schools is critical to developing a school-linked dental program. LOHPs can partner with schools, school boards, school districts, and county offices of education (COEs) to improve access to oral health care through school oral health programs, integration of oral health education into school curriculum, and oral health literacy among school staff. Champions at schools who can promote school oral health programs include school superintendents, parent liaisons such as parent teacher organizations, school teachers, and school nurses. LOHPs can also work with existing school-based health centers to implement oral health programs or further enhance existing programs.

Health care professionals

Dental providers, pediatricians, Federally Qualified Health Centers (FQHCs), other community clinics, school nurses

LOHPs can collaborate with health care professionals in several ways. Local dental providers, including FQHC dental providers, can participate in the referral pathway for children to access dental care by serving as dental homes. Local dental providers can be engaged to provide a range of school-linked/-based oral health services including screenings, fluoride application, sealants, and other preventive care. LOHPs can also enhance medical-dental integration by collaborating with medical providers to implement oral health literacy campaigns for parents and caregivers.

School nurses serve as a valuable resource to identify, educate, and coordinate oral health activities. They could also be trained to conduct oral health screenings (but not KOHA), identify disease and injury, provide oral health education and dietary counseling, and coordinate care.

LOHPs can also partner with community-based organizations whose scope of work aligns with the goals and objectives of LOHPs. They can identify organizations/agencies already offering services geared towards improving children's oral health through screenings, education, or other activities.

Community organizations and agencies

Community dental centers or FQHCs can be partnered with to establish school-linked/-based dental programs and/or to serve as safety net dental clinics for underserved populations.

Several organizations in the community often serve the same populations in improving health outcomes. Collaborating and coordinating services between such organizations can maximize the usage of available resources.

Partnering with other departments within the public health agency can provide access to resources that can be utilized to improve oral health and raise awareness. Departments such as Maternal, Child, and Adolescent Health (MCAH); Nutrition, Education, and Obesity (NEOP); Tobacco Cessation; and Women, Infants, and Children (WIC) can be engaged to increase oral health literacy and maximize the usage of resources.

Partnering with early childhood programs such as Head Start and First 5 can provide an opportunity for early intervention to improve the oral health of children and parents enrolled in the program through oral health education, campaigns, and programs. More resources for
implementing toothbrushing programs and partnership examples can be found on the COHTAC website.

Professional groups and health professions schools

Local dental societies, American Academy of Pediatrics (AAP) local chapter, school nurse associations, dental schools, dental hygiene schools

LOHPs can partner with local professional societies to identify ways to develop the workforce and increase providers accepting Medi-Cal Dental. Partnering with your local AAP chapter can facilitate promoting oral health into routine medical visits.

Professional organizations like the California School Nurses Organization can be partnered with to promote oral health among students and their families. Partnering with dental schools or dental hygiene schools can help build school oral health services infrastructure and oral health education.

Building relationships with these societies and schools can also facilitate volunteer opportunities and referral pathways.

Communicating Effectively with Potential Partners

Effective communication is vital when sharing a program proposal with potential partners to gain their support. Tailor communication strategies to be relevant to the appropriate audience. Engaging oral health champions who strongly believe in the mission to improve oral health and who can successfully relay the message can gain support for the cause.

Communication strategies that can be utilized

Assessment of perceptions of oral health issues using key informants and opinion leaders.
Communicating with change agents who can affect policy and systems changes.
Broadening the range of stakeholders who are engaged in policy assessment and education.
Using local level data on caries prevalence (if available) to demonstrate the need overall and/or stratified by race/ethnicity or geographic region.
Combining data and stories to create compelling arguments for advancing oral health.
Developing comprehensive risk communication strategies for oral health issues.
Using health economics, business concepts, and language to describe the value of oral health programs.

Talking points for promoting a school-linked oral health program to potential partners

LOHPs can implement effective communication strategies to raise the awareness of the importance of oral health and gain buy-in. The following are examples of talking points for LOHPs when promoting a school-linked oral health program to potential partners:

“The most common chronic disease for children isn’t asthma. And it isn’t diabetes. It is tooth decay. But here’s the good news - tooth decay is 100% preventable.”
“Untreated cavities are more than just unsightly – they can lead to tooth infections, known as abscesses, which can destroy the pulp inside the tooth. In time, these deep infections can even cause a child to lose a tooth.”
“Untreated cavities can interfere with a child’s everyday life. Cavity pain can make it hard to eat, speak, and sleep and the pain from tooth decay can prevent a child from playing and learning.”
“Healthy baby teeth hold space for permanent teeth and help guide them into the correct position. Severe decay and early loss of baby teeth can result in crowded, crooked permanent teeth.”
“Research shows that children who have dental problems miss more school and get lower grades than children without oral health problems. Early detection, tooth fillings, and other treatments can stop tooth decay and more serious problems.”
“Early detection and treatment of tooth decay and other oral health problems is essential for healthy teeth. Going to the dentist for dental exams and cleaning at a young age also helps children feel more comfortable and less stressed out about visiting the dentist.”
“Children with healthy mouths have a better chance of general health because disease in the mouth can endanger the rest of the body. Consequences of early childhood caries include insufficient physical development (especially height and weight) and a diminished ability to learn.”
“According to the National Association of School Nurses, forty percent of school nurses report they encounter students who avoid smiling or laughing because of oral health problems. Good oral health is not only essential for overall physical health but also good mental health.”

Developing a Memorandum of Understanding

A memorandum of understanding (MOU) is a formalized statement describing the terms and conditions of an agreement between two or more entities intending to collaborate toward a shared line of action. After having identified partners, the next step is to formalize the working relationship. Familiarity with the scope of work of each partner is essential before drawing up the terms and conditions. A series of discussions and brainstorming sessions between collaborating partners will enable each party to identify the essential steps of the program and the main aspects to incorporate under each section of the MOU. These preliminary discussions help partners reach common ground through negotiations and mutual agreement to work together to achieve the chosen goals.

Key Elements of an MOU

The critical elements of an MOU include, but are not limited to, the following:

Purpose of the MOU
Identify the collaborating partner(s) and their role(s)
Enlist terms and conditions
1. Identify logistical requirements
2. Identify the required level of assistance
3. Care coordination
4. Quality assurance and data collection
Indemnification
Timeline and termination
Signatures

Additional guidelines can be found here, with sample MOUs linked below. You can also view a webinar on establishing MOUs here.

Sample MOUs

Create a Quality Improvement (QI) Plan

A quality improvement (QI) plan is an essential element of a program which allows you to track its progress. Developing a QI plan at the time of program planning can ensure a way to measure if the program is accomplishing the desired goals and objectives.

QI based on performance measures involves the practice of data-driven performance improvement to reduce redundancies, streamline processes, cut down costs, and improve outcomes.

Steps to developing a QI plan

Define the purpose, goals, and objectives of the plan
Identify the Quality Improvement Team (QIT) - the QIT should include individuals representing all areas of the process that will be affected by the proposed improvement and/or the Advisory Committee but should also be limited to eight (8) members.
List roles and responsibilities
Select a QI method (see more below). Example methods include:
- Plan Do Study Act (PDSA)
- Lean
- Process Mapping
- Value Stream
- Root Cause Analysis
Set a meeting schedule
Identify the steps to track, review, evaluate, and revise the plan

An example of a QI plan for a school dental program:

Program Objective

Evaluation Question

Performance Measure

Aim Statement

Specific actionable targets for the program to achieve their goal (should be SMART+C: Specific, Measurable, Achievable, Relevant, Timed, and Challenging)

Evaluation questions help assess whether the program objectives are being accomplished.

Key performance indicators of various aspects of a program that act as targets to provide insights that can be used as feedback on the program process.

A concise, specific, written statement that will determine what the QI efforts will accomplish.

By January 1, 2025, implement a dental screening program connecting parents/caregivers to a source of dental care and ensures 40% of schools are tracking the progress of care from referral to completion.

How did the attitude of parents/caregivers of students change towards prioritizing oral health following the implementation of a school-based program?

% of students participating in the school dental program.

By one (1) year anniversary of the implementation of the school dental program, 80% of the students will have established a dental home.

PDSA (Plan Do Study Act) Model

The Plan Do Study Act (PDSA) method is an iterative, four-step problem-solving model used for improving a process or carrying out change. It can be utilized to obtain quick feedback on the program’s progress. The model is executed and documented appropriately along the progress through the four steps.

Step 1. Plan

As an initial step, identify the objective of the evaluation process and formulate a statement predicting what is the intended result (create a hypothesis).
Create an action plan by identifying the who, where, when and how long, what, and how the evaluation process is to occur.
List the resources, including staff, that would be necessary to carry out the evaluation process.
Create a data collection plan by identifying what data is to be collected and how it will be collected.
Tips for the PDSA model:
- Identify a single aspect of the program to evaluate.
- PDSA cycle usually lasts a short duration.
- Involve a small sample of the program participants.

Step 4. Act

Identify the next steps based on whether the findings were favorable.
Adapt, adopt, or abandon based on the finding
- Adapt: If the plan was mostly successful, but the data suggests that the improvement could be further improved, then repeat the PDSA cycle and modify the intervention(s).
- Adopt: If the plan resulted in success, begin to use it regularly. After some time, return to Step 1. Plan and re-examine the process to learn where it can be further improved.
- Abandon: If a different approach would be more successful, return to Step 1. Plan, and develop a new and different plan that might result in success.

Other QI Methods and Resources

Root Cause Analysis

Root cause analysis is a technique for determining the reasons a particular problem occurred. It is a systematic approach to identify the source of the problem so that necessary steps can be taken in the future to prevent it from happening again.

Examples and resources for root cause analysis: