A visit to the dentist isn’t usually something most people look forward to. But for
the patients at Central Arizona Shelter Services (CASS) Dental Clinic for the
Homeless – who are either homeless, addicted to drugs or may have been abused – a visit to the dentist means a new lease on life.
The CASS Dental Clinic, in Phoenix, Arizona, is the largest volunteer dental clinic
in the United States, offering comprehensive dental care for the homeless. What began
in a cramped trailer in 2001 is now a state-of-the-art facility, which operates solely on
generous donations and selfless volunteers, and run by Kris Volcheck, DDS, MBA.
Volcheck, a tall, modest man with a magnetic smile and booming baritone laugh,
is the reason CASS has a dental clinic in the first place. In 1985, Volcheck graduated
from dental school at Emory University and began practicing in Globe, Arizona. But
after 10 years of practice, Volcheck was done.
“I loved hanging out with my patients, but the actual dentistry? No thanks. I
don’t like constructing things in small spaces,” he says. While he was still in practice,
Volcheck earned his MBA at Arizona State University, and around the time he graduated,
he met Mary Orton, founder and then director of CASS.
“Mary and I hit it off and she suggested I come down and volunteer at the shelter,”
says Volcheck. So he did, volunteering part time – handing out clothing, feeding
people and delivering packages to homeless people living under bridges.
Everything he did had nothing to do with dentistry. Soon CASS hired him on as a
social worker, which he did for six years.
CASS was able to help the homeless in many ways, but the largest need it was
unable to meet was dentistry. Volcheck proposed a volunteer-based dentistry program
and, logically, since he was a dentist he would spearhead the project. Because
there was such a huge need for dentistry within the Phoenix-area homeless population,
Volcheck realized he needed help, so he began asking local dental professionals
to volunteer. “I am not good at many things,” says Volcheck. “I can be pretty disorganized,
but I can get you to help the homeless.”
On January 1, 2001, the CASS Dental Clinic opened out of a trailer, which was
donated by the Arizona Office of Oral Health, along with 20 dentist volunteers and
15 hygienist volunteers. More than eight years later and with much help, the clinic
has its own eight-operatory facility and volunteers now number in the hundreds.
Operations
“We are 100 percent non-profit,” says Volcheck. “CASS is the largest clinic of it’s
kind for homeless in the nation. Things we do, like implants, cosmetics and dentures
are unheard of in the homeless setting. The reason why we do it is because it is
absolutely necessary. Because it’s necessary, we do everything that every other nonprofit
does like fundraisers and donations from companies like Henry Schein. We get
things in bulk from Oral Health Relief, but even with all of that it is still extremely
expensive to run this facility.” The clinic’s operating budget is about $700,000, and
its production runs several million dollars, but every single person operating on the
patient is a volunteer and everything is free for each patient.
Standing in the middle of the clinic, you don’t get a feeling that all of the
patients are being treated for free. From the equipment used to the restorations for
every single patient to the roof over their heads – all of it is donated. When the
clinic moved out of the trailer, Gordon Osterhaus of Valley Dental Consulting
helped design and build the new dental facility. All eight of the operatories are
equipped by generous donations from Pelton & Crane, A-dec and KaVo. The clinic
treats the operatories as a showroom (after all, more than 300 dentists come
through to volunteer their time each year), and because of that, all of the equipment
is fairly high-end. Becker-Parkin filled the entire clinic with supplies, instruments
and cassettes for free. Totaltek, a local IT company, wired the facility so it
could operate digitally and completely paperless.
Even during downtime the clinic is bustling, but there is very little chaos, thanks
in most part to Dr. Gretchen Henson a volunteer dentist who runs her own practice
in Ahwatukee, Arizona. “Dr. Henson is the reason this clinic is so well organized and
runs the way it does,” says Volcheck. “She volunteers here twice a week and is sort of
my assistant director. She is why we are paperless, why all our systems are in place,
why our OSHA is in place. She brought her systems from her office – patient flow,
routing forms, check-in and checkout of patients, how dental students present to the
faculty, etc. She brought all of her for-profit knowledge from her office into CASS.”
CASS Dental Clinic is the only dental clinic in the state of Arizona that serves
the homeless, and because of this every single patient is scheduled. The clinic takes
in emergencies, most of which are seen within an hour. Because there is a fair amount
of unreliability in patients keeping schedules, scheduled patients arrive and are seen
on a first-come, first-served basis. The morning session begins at 9 a.m. and the afternoon
session starts at 1 p.m. Most of the patients arrive from the CASS campus, but
some arrive from the 30 other small homeless shelters across the Phoenix metropolitan
area. Every shelter that refers into CASS Dental Clinic funnels through one entity
that presents the patients to CASS in a priority list. When the front desk at CASS
gets the list, patients are scheduled depending on which dentists are volunteering.
“We have had patients come in from Flagstaff and Tucson,” says Volcheck. “Most of
our population comes from Phoenix, but when it gets extreme, people from other areas
head here. We do every area of dentistry – every specialty. We do implants and cosmetic cases every week. We even have a couple plastic surgeons on staff because a high percentage
of the women who are homeless are victims of domestic violence. They have mangled
teeth or broken oral structures, so the plastic surgeons will work with the dentist to
do the cosmetic repair and plastic surgery as well. Some of the most touching cases we
work on have to do with domestic violence victims. When they get a new smile, they are
overwhelmed. They get their smiles back, which they never thought they ever would.”
Aside from drafting volunteers and because of his work history as a social
worker, Volcheck has the unique role at CASS to make sure all treatment plans are
appropriate for the homeless patients.
“I still do no dentistry,” says Volcheck. “But because volunteers can’t really
treatment plan for the homeless, I have to make sure the treatment plans are appropriate.
Say for example, the patient is a paranoid schizophrenic, well partials and
dentures won’t last in their mouths for a day. If they are not stable with their home
lives, then there are only certain things that I can do with them. I have to decide if
they are stable enough to get fillings and once they move into a home and can take
care of their hygiene then maybe they can move up to crown and bridge or cosmetic
work, but I can’t teach dentists how to determine that.”
The clinic sees everything from people still living on the street who require emergency
care to formerly homeless people who might now be working at Macy’s for whom
big resources are reserved such as implants or veneers. Those people get full cosmetic
treatment because they are stable and can take care of their hygiene.
Patient recovery presents another dilemma, but even though the clinic has to
walk a fine line in some cases, CASS manages its patients’ health well, which has
taught Volcheck a thing or two about the dental profession.
“With an addict, you don’t want to give them something that is going to get
them hooked again, like Vicodin or Percocet, but if you cause them too much pain
they might go out and self medicate,” says Volcheck. “I will tell you that with most
of the cases we do, high doses of ibuprofen work. This place has confirmed to me
that dentists overmedicate their patients. Now, if we’re doing alveoplasty, we will
give them something, but those are typically patients who are more stable.
Typically, the patients who are on crack or drugs come in for emergency care and
extractions – they’re not here for comprehensive care.”
Still Much More to Do
The day-to-day operation of CASS keeps Volcheck and his staff pretty busy, as
you can imagine, but their work is compounded by the help they offer to other
metropolitan areas around the world in developing programs like this.
“We have helped a lot of cities do this model,” says Volcheck. “We’ve helped
San Antonio, San Francisco and Pittsburgh, and we’ve had about 15 other cities
come in to learn our model and our program. Right now, we are working with
Bangalore, India. The thing is, I wouldn’t have been able to do this kind of program
in Pittsburgh or New York. Phoenix is such a dynamic place. This type of
clinic was easier to build here than in more entrenched cities.”
Things are about to get even busier as CASS is opening a second facility on 35th
and Buckeye in Phoenix. CASS is opening a dental clinic for the Murphy Elementary
School District – an extremely impoverished district that works very closely with CASS.
“An innovative superintendent, Paul Moore, has a new medical, educational,
childcare facility over there. But they couldn’t do dental because they didn’t have
the expertise or the knowledge, so I met him and said, ‘Let’s go.’”
The second facility is currently being built out, but the program is already in
operation – in a very familiar trailer.
If you would like to get involved or if you’d like more information about
CASS Dental Clinic
for the Homeless, please visit www.cassdentalclinic.com, e-mail kvolcheck@cass-az.org,
or call 602-256-6945. |
The Lab Component
When the CASS Dental Clinic opened, a local
Phoenix TV station ran a public service story in
which Dr. Kris Volcheck implored local dental
professionals to help the program any way they
could. In the broadcast, Volcheck said he needed
dentists and hygienists, but Genny Bolles, who
was watching the report over lunch thought,
“What about lab technicians?” Bolles, a longtime
dental lab technician and owner and operator
of Vitech Dental Lab in Phoenix, called the
phone number provided in the news story and
spoke to Volcheck personally.
“What about lab technicians?” she asked
Volcheck.
“I honestly didn’t think we could get any labs
involved,” Volcheck replied. But lab involvement
turned into one of the most crucial elements of
operating the CASS Dental Clinic. Bolles reached
out to her lab connections and convinced them to
donate cases to CASS.
“I told them the more labs we can get to do
this, the fewer cases we’ll all have to do,” says
Bolles. Between 20 and 30 labs got involved and
pledged to help CASS as much as they could.
Some labs will do a couple cases each year, but
others, like Gold Dust Dental Lab in Tempe,
Arizona, will do several units a month.
“We really believe in their mission of serving
the underserved,” says Jenn Robertson, COO of
Gold Dust Dental Lab. “There is no greater cause
locally that has the ability to get so many people’s
lives back on track. There’s a community
spirit there that’s just awesome. We couldn’t not
contribute our services to CASS.”
“Labs like Gold Dust will do 10 units a month
for us and I have other labs that will do one unit
a year. That is the beauty of labs; when I am
vacationing and I can stop in labs and ask, ‘Can
you help me out in Phoenix once a year?’ and
they say, ‘Sure I can do once a year,’ but they end
up doing two or three a year – that’s great! We
have labs in 15 states, but we can really use
more lab involvement at CASS,” says Volcheck.
Bolles, who got the ball rolling all those years
ago, still volunteers her services to CASS whenever
she can. She likes that she’s able to keep
working – and for a good cause. “I don’t make a
lot of money,” says Bolles. “So since I can’t
donate to charity, I can work for charity.” |