FQHC Best Practices/Program Background and History

Survey Purpose:

The purpose of this survey is to collect information regarding emerging, promising, and best practice programs related to veteran oral health in community health centers around the country. Survey questions will assess program background and history, strategies to improve veteran oral health, per capita cost of delivery of oral health care for veterans, as well as approaches to enhance the care experience of veterans, and care delivery by the healthcare team. The results from this survey will be reviewed by a workgroup of experts identified by NNOHA and AIDPH to create a developing practices resource guide for dissemination amongst community health centers. This project is funded through NNOHA's HRSA National Training and Technical Assistance Partnership.

Survey Instructions:

Who should fill it out? Individuals in leadership positions within their organizations, this includes, but is not limited to a dental director / chief dental officer, medical director / chief medical officer, office manger, or outreach coordinator.

One submission per organization.

Please complete each question to the best of your abilities. If you are unable to answer a question, please state ‘unknown’, N/A, or leave blank.

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* 1. Provide the name of person completing the emerging, promising, or best practice form.

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* 2. Provide the email contact of person completing the emerging, promising, or best practice form.

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* 3. What is the name your of emerging, promising, or best practice program?

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* 4. If applicable: What is the name the parent program or organization associated with the best practice program? (e.g. Veteran Smiles is associated with XYZ Health Center)

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* 5. Please provide a brief description of your emerging, promising, or best practice / program.

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* 6. Where is your organization located? Please provide the city and state

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* 7. Please provide your organization website and/or social media address.

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* 8. Can we include your contact information in our emerging, promising, or best practice / program publication?

Yes

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* 9. What year was the emerging, promising, or best practice/program initiated or founded?

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* 10. Describe the mission, vision, and scope of your veteran oral health program

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* 11. Which aspect(s) of veteran oral health are you targeting? (Select all that apply)

Patient recruitment, access navigation, personalized communication, and front office excellence

Clinical care delivery (direct patient contact)

Patient and community engagement and involvement

Other (please specify)

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* 12. What revenue sources are currently used to maintain regular day-to-day operations of the emerging, promising, or best practice program? (Select all that apply)

Independent donations

Grant funding from non-profit (501 c 3) organizations

Grant funding from corporate giving, venture philanthropy, or 501 c 4 organizations

Federal grant monies

State government or agency grant monies

Patient payments for care services

Donated clinical provider time and supplies for dental care services

Medicaid or Medicaid reimbursement for services provided

Long-term endowment

Other (please specify)

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* 13. Approximately, how many veterans are served in this program annually?

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* 14. Considering the last 12 months, the emerging, promising, or best practice program has:

Expand in size or scope

Maintain its current size or scope

Decrease its current size or scope

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* 15. Considering the next 12 months, the emerging, promising, or best practice program is expected to:

Expand in size or scope

Maintain its current size or scope

Decrease its current size or scope

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* 16. Please provide website addresses or links to any research, publications, or presentations that include your emerging, promising, or best practice/program.

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* 17. Please select which of the following people or entities work within the emerging, promising, or best practice / program. (Only select those that apply and categorize as directly or indirectly utilized)

	Indirectly	Directly
Dentists	Dentists Indirectly	Dentists Directly
Dental hygienists	Dental hygienists Indirectly	Dental hygienists Directly
Dental assistants	Dental assistants Indirectly	Dental assistants Directly
Front office personnel	Front office personnel Indirectly	Front office personnel Directly
Billing and finance	Billing and finance Indirectly	Billing and finance Directly
Primary care providers	Primary care providers Indirectly	Primary care providers Directly
Community health worker	Community health worker Indirectly	Community health worker Directly
Behavioral health provider	Behavioral health provider Indirectly	Behavioral health provider Directly
Community support organizations	Community support organizations Indirectly	Community support organizations Directly
Veteran support organizations	Veteran support organizations Indirectly	Veteran support organizations Directly
Medical specialists	Medical specialists Indirectly	Medical specialists Directly
Executive / Admin personnel	Executive / Admin personnel Indirectly	Executive / Admin personnel Directly

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* 18. Please describe the measures or types of measurement employed to evaluate the emerging, promising, or best practice/ program:

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* 19. What were the main activities carried out as part of this emerging, promising, or best practice / program?

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* 20. Was an assessment or analysis of emerging, promising, or best practice / program completed?

Yes