Bringing Dental Care to Homeless and Low-Income People
Originally posted: April 10, 2015
Last updated: October 16, 2015
Position at time of the award: Director, Central Arizona Shelter Services Dental Clinic for the Homeless; Phoenix, Ariz.
Current position: Same as above
In 2010, the Robert Wood Johnson Foundation (RWJF) named Kris Volcheck, DDS, MBA, one of 10 RWJF Community Health Leaders, recognizing his extraordinary leadership in developing a volunteer-driven model for delivering free dental care to homeless people.
Volcheck directs the Central Arizona Shelter Services (CASS) Dental Clinic for the Homeless in Phoenix, which provides comprehensive oral health services to homeless and low-income adults who would otherwise not be able to afford care. Beginning in 2010, the clinic extended its dental services to children living in impoverished neighborhoods in Phoenix.
The problem. Some 40 percent of low-income children in Arizona lack access to dental care.
Children with poor oral health miss thousands of hours of school due to painful teeth and gums; suffer from malnutrition due to their inability to eat fresh, nutritious foods; and suffer from low self-esteem because of their socially unacceptable smiles.
Medicaid and uninsured children are especially unlikely to receive adequate dental care. More than half of the Medicaid-insured children in Arizona received no dental services in 2007, according to the Pew Center for the States 2010 report, The Cost of Delay: State Dental Policies Fail One in Five Children.
Poor dental health can escalate into far more serious problems later in life. The Pew report also notes that a growing body of research indicates that periodontal disease—gum disease—is linked to cardiovascular disease, diabetes, and stroke.
Entering and leaving dentistry. Growing up, Kris Volcheck looked forward to going to the dentist, which made him a rarity. “My dentist was an old family friend and had this big personality,” Volcheck recalls. “He would talk to me as my lips got numb. I just thought he was a really cool guy.”
Volcheck was so impressed, in fact, that when it came time to choose a career for himself, he chose dentistry. After his training at Emory University in Atlanta, Volcheck opened a private practice in Arizona, but 10 years in, he had to admit that being a dentist was not for him.
“I am a high energy guy, and very easily distracted,” he says. “And I don’t like working with my hands, don’t like small spaces, don’t like people in pain, and don’t like being the cause of people in pain. You just can’t get around all of that in dentistry.”
While still practicing as a dentist, Volcheck went back to school at Arizona State University to get an MBA. “I was pretty distraught about leaving dentistry,” he recalls, “but I decided I really needed to make a move while I was still young enough.”
Finding a home working with the homeless. At the graduation ceremony for the MBA program, Volcheck met Mary Orton, at the time executive director of Central Arizona Shelter Services (CASS). Orton was giving a presentation about career possibilities for recent MBA graduates in the nonprofit field and invited Volcheck to help out at the shelter while he was looking for his new career.
Volcheck’s first exposure to a place where homeless people congregated was intimidating, he recalls. “I’m from a small coal-mining town in Pennsylvania and had never been exposed to any of that,” he says. “I couldn’t get out of the car for 30 minutes because I was too scared.”
But once he stepped into the world of street work, Volcheck felt at home. “I was on the street doing outreach, handing out clothing, helping with the drug addicts coming in,” he says. “That was perfect for my personality.”
After working as a volunteer for two years, Volcheck took a paid position as a case manager. Working on the ground directly with homeless people allowed him to overcome his “naiveté” about issues relating to homelessness. “In private practice you have those issues, but the degree is so much less. The issues with homeless are right up front.”
Returning to dentistry. One shocking realization was that homeless people got little or no dental care, and that put ideas in Volcheck’s head. “I had told myself that I was done with dentistry,” he recalls. “But then I thought, ‘Oh, I could do a volunteer clinic here. I wouldn’t have to do dentistry myself. This would all fit.’”
The new CEO of CASS said yes and the state of Arizona provided a trailer with two dentist chairs, free of charge. Volcheck pulled the trailer into the park behind the shelter and on January 1, 2001, opened the CASS Dental Clinic for the Homeless.
“There was no advertising done, no need for outreach,” Volcheck says. “As soon as we opened a dental clinic in the park, the word got out. I could have built 10 clinics and still not met the demand.”
Building on volunteers. In 2005, six Phoenix nonprofits joined to create a new “campus” to house services for the city’s homeless people. The CASS Dental Clinic was a partner in that effort and, with support from government contracts, corporations, and foundations, built an eight-chair, $1.6 million facility. That clinic serves some 10,000 patients a year as of 2015, including a large population of homeless veterans.
Volunteers are at the heart of the clinic’s ability to do its work. More than 500 doctors and students in every area of dentistry, hygienists, dental assistants, and dental labs throughout the nation, volunteer their time and services.
The clinic is state of the art. “We do full mouth rehabilitation, implants, cleft palate repair, and cosmetic surgery, which is very important for domestic violence victims,” Volcheck says. “Every specialty you could imagine is under one roof.”
Expanding dental services to children and schools. The CASS Dental Clinic had established a program specifically for homeless children in 2007. But in the nearby impoverished Murphy School District, many of the families lived on minimal incomes and had no transportation, making the trek to dentists or other medical centers difficult.
“When basic health care is secondary to just surviving,” Volcheck wrote in a blog post in 2011, “oral health care falls by the wayside.”
To address this need, in 2010 Volcheck and his team created the first and only fully portable, self-contained, school-based comprehensive dental clinic in Arizona. Three portable treatment chairs, a hand-held X-ray machine, laptop computers, and a Web-based dental practice management system allow the Murphy Kids Dental Clinic to setup and operate in an open classroom or auditorium. Children are escorted to the clinic only during their free periods, taking care not to disrupt their education as dental services can in other school-based models.
Winning trust in the neighborhood. The school-based clinic was not immediately embraced in the largely Hispanic neighborhood. For one thing, portable dental clinics in Arizona are unregulated, and according to Volcheck, have had a reputation for giving subpar care with little oversight. Another barrier was fear of immigration authorities. “Our families are split 50/50 between documented and undocumented,” Volcheck says. “Arizona is a border state that has implemented or attempted to implement draconian anti-immigrant measures.”
To overcome these perceptions, Volcheck and his team promoted the dental clinic exclusively in Spanish, at neighborhood health fairs, school events, and other community gatherings, as well as on Spanish radio and in Spanish print publications. Clinic staff is bilingual and the clinic employs many Mexican-Americans from the neighborhood to be assistants and receptionists.
Reaching moms through coffee klatches and other gatherings also has been key, Volcheck says. “The most powerful tool has been word of mouth, from mom to mom, but that has taken awhile.”
Becoming a Community Health Leader. In 2010, RWJF named Volcheck a Community Health Leader for his innovation in rallying a huge contingent of volunteers to address the dental needs of homeless and low-income adults and children.
Volcheck used the $105,000 project portion of his RWJF award to collect clinical data to identify the three most prevalent oral health problems of the children in the Murphy School District and to develop a strategy to address them. Oral health assessments on some 1,148 school children found that the top three oral health problems were tooth decay, gingivitis (inflammation of the gums), and infection (abscesses).
The team also found a “staggering absence of knowledge about daily hygiene practices and preventative care,” Volcheck reported to RWJF. As part of the RWJF project, Volcheck contracted with a videographer to produce videos demonstrating proper dental hygiene for children at different age levels, starting as soon as their teeth come in.
By 2012 the Murphy Kids Dental Clinic was operating in temporary space in a neighborhood community center to address more complicated dental care, while continuing the portable unit for routine care.
Connecting dental patients with insurance. Clinic staff discovered that many uninsured children they served were eligible for Medicaid but their parents had either become overwhelmed with the process or were afraid that getting enrolled would attract the attention of government agencies. The clinic helped to connect families to community services that could ease these concerns and obtain coverage.
Maria, one of the clinic’s young patients, convinced her mother to allow the clinic’s dentist to examine Luis, her two-year old brother who had been crying uncontrollably for weeks, not sleeping and unable to eat solid food. To keep Luis nourished, his mother bottle-fed him orange and apple juice day and night. The family lacks health insurance, so did not seek medical attention for Luis.
The dentist caring for Luis found that each of his 16 teeth was severely decayed and that he had two large abscesses. Four teeth had to be pulled and eight molars were filled and crowned. With antibiotics, Luis’ abscesses resolved without complication. With his pain relieved, and his oral and overall health restored, Luis is now thriving.
Sustaining the effort. In 2014, CASS received a multi-year grant from the Bob & Renee Parsons Foundation to renovate the dental clinic space in the community center into a state-of-the-art facility serving at-risk children in the Murphy School District. The clinic opened September 3, 2014.
The $1.4 million award will enable the pediatric dental clinic to triple its capacity over three years. By adding new treatment chairs and extending the dental clinic’s reach into other school districts, it is projected that the clinic will serve 15,000 children by 2017.
In February 2015, the clinic extended its reach down the street to the UMOM New Day Center shelter for homeless families. The portable unit will handle routine dental care for the 400–500 adults and children served by UMOM New Day Center each year. For more extensive care, adults will go to the CASS Dental Clinic for the Homeless, and children to the new The Parsons Center for Pediatric Dentistry at Murphy.
Finding the optimal mix of insured and uninsured patients is the key to sustaining dental care for low-income people, Volcheck says. Getting reimbursement for care from patients that have insurance helps to pay for those that do not.
“If we can make this sustainable, we can then look at opening the next clinic,” Volcheck says. “We will be in the black and will stay in the black.”
The “Medical Oscar.” The prestige of the RWJF award was instrumental in leveraging an additional $1.6 million from foundations and government agencies for the startup of the children’s dental clinic, Volcheck says. “The award is like the Oscars of the medical community,” he says. “It gave me so much credibility and legitimacy.”
The award has also provided Volcheck with a community of colleagues to turn to for advice and counsel. “The most important thing to me in life is establishing meaningful relationships,” Volcheck says. “That is what has happened with our Community Health Leaders class. We are planning our next reunion ourselves, even though the program has closed.”
Postscript. As of October 2015, Harvey still serves as director of CASS Dental Clinic for the Homeless.
RWJF perspective. The Foundation recognized the first 10 RWJF Community Health Leaders in 1993—unsung and inspiring individuals who work in their communities, often among the most disenfranchised populations, to address some of the nation’s most intractable health care problems. The last round of leaders was chosen in the fall of 2012. The program closed at the end of 2014. For more information on the program see the Special Report.
of low-income children in AZ lack access to dental care; highest % in USA. Kris Volcheck changed that.