G-2207-17508

The Massachusetts League of Community Health Centers (Mass League) is the primary care association in Massachusetts and a long-term partner of CareQuest Institute. Historical partnership within CareQuest Institute’s Legacy grantmaking supported the initial development of an Office of Oral Health Affairs at the organization and led into deeper work with several state and national initiatives, such as Strengthening the Oral Health Safety Net and the National Oral Health Innovation and Integration Network.

Mass League was also a partner of CareQuest Institute in the piloting of the inaugural phase of COrHT in 2020 and has focused their work over the past year on expanding the use of teledentistry in the safety net as well as strengthening the capacity of community health centers to gather and use social determinant of health data, from which they developed a toolkit. Mass League is also currently in the process of launching a Health Equity Research, Evaluation, and Policy Institute (Equity Institute) that will conduct participatory research on health inequities and provide career development opportunities for CHC workforce to help support more equitable policies moving forward. With this proposal, Mass League will launch the first phase of a multi-year project that represents the inaugural project of the Equity Institute.

The intent of the project is to improve patient-provider communication and health equity at community health centers through the creation of an oral health communication primer and training modules to improve patient-provider communications. This is an anti-racist framework that Mass League expects will further person-centered care and it will evaluate the effect of training health center staff on health outcomes as well as overall patient satisfaction, with a particular focus on BIPOC-identifying individuals, with the broader care team and health center staff. The genesis of this pilot stems from a combination of national research indicating Black patients receive a lesser quality of oral health care than their white counterparts as well as research indicating ineffective communication strategies among racially discordant patient/provider pairs in oral health often negatively affects preventative oral health care. This work also grows out of direct experiences and lessons learned by Mass League in supporting their health centers to provide high quality oral health care.

The project will be carried out in three phases:

Phase 1: Mass League will conduct qualitative interviews with stakeholders (providers, patients, dental department staff, dental school partners) to understand provider and patient perceptions on concordance and other factors (SDOH). Mass League will develop an interview guide to better understand the perceptions around concordance, implement a series of statewide interviews and synthesize the information obtained around what communication strategies are currently being used and what communication challenges certain strategies may address to improve equitable, quality care.

Phase 2: Based on the findings from the interviews, Mass League will develop a “primer”, or short booklet, for oral health staff at health centers to support their capacity to strengthen relationships with patients, with particular attention to BIPOC patients. This primer will be a “how to” narrative with strategies for staff that will be disseminated statewide.

Phase 3: Using the information from the interviews and the primer, Mass League will then contract with Tufts University School of Dental Medicine (TUSDM) to create new training modules to address factors contributing to structural racism in dental public health. In partnership with Tufts University School of Dental Medicine, Mass League will assist in assessing and developing new education content for a training series for oral health staff at health centers. During this phase, the organization will pilot new educational content through experiential learning with three community health centers (already committed) and evaluate training modules by developing metrics to measure change.

With respect to partners, Tufts is the primary partner outside of the community health centers that will be engaged during the phases described. Mass League shared that many students and residents at TUSDM will interact with member health centers and benefit from this training. Further, the faculty at TUSDM who will be supporting the development of the training series are professors and academics who identify as BIPOC.

Mass League will be able to evaluate the use of the primer and training modules through surveys as well as the number of participants being trained “touched” by the project through training on the modules. For this year’s proposal, Mass League anticipates being able to fully complete all phases of this project. Patient perspectives will inform and guide the project through the development of the primer and provide insight into their experiences and satisfaction with clinical and non-clinical staff through instances of care. Beyond informing the materials produced, Mass League also expressed a commitment to engaging the patients on health center boards and other opportunities for community power building are being explored.

The original request was reviewed in December 2022 and included the outlined phases of work above, as well as an additional three phases, for $367,000. The recommendation from the Review Committee was to explore a reduced budget and scope of work to accommodate a 12-month grant timeline, resulting in a revised proposal submission for at a reduced total dollar amount of $150,000. This proposal is being recommended for funding at this revised level. This recommendation is based on interest in partnering in the learning and development of the tools to fully understand both their value, their intended outcomes, and the future spread/scale opportunities. Additionally, the revised project timeline and scope will allow for more time and opportunities for patients to participate and provide input before moving to subsequent phases. In follow up discussion with Mass League, it was clear that this is work that the organization is passionate about and the subgrants to health centers will make their participation possible due to capacity needs across the state. CareQuest Institute's Grants team did reconnect with Mass League staff about the budget reduction and the consensus from Mass League was to modify the scope of work and several budgetary lines to move forward.

The total organizational budget for Mass League is $35,864,721 which means the recommended amount of funding represents less than 1% of the total organizational budget.