Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Public Policy & Administration

First Advisor

Sarah Jane Brubaker

Second Advisor

Sarah Raskin

Third Advisor

Tegwyn Brickhouse

Fourth Advisor

Adai Tefera


In terms of unmet needs for people with disabilities (PWD), dental care is number three behind residential care and employment (Fisher, 2012). Regardless of disability, oral healthcare traverses all disability diagnoses and can be a significant factor in quality of life (Deckler, 2011; Griffin et al., 2007; Norwood & Slayton, 2013). When attempting to secure oral healthcare, people with disabilities face many challenges, including lack of access, lack of provider education on proper care of PWD, and difficulty finding a willing dental provider (Deckler, 2011; Fisher, 2012; Kennedy, 2009).

The purpose of this study was to investigate professional practices and decisions that affect provision of care for patients with disabilities. Research has clearly identified many barriers that preclude dental professionals from providing adequate care, such as lack of physical accommodations or reluctance to participate in state Medicaid programs (Deckler, 2011; Fisher, 2012; Kennedy, 2009). This study sought to understand the interoffice decision-making processes regarding participation in Medicaid, how to treat or accommodate patients with disabilities, and the extent to which market factors influenced these decisions.

Using the paradigm of institutional ethnography, this research provides insight into factors that providers considered when making decisions about patient care, and how local office decisions are connected to larger institutions and policies. A qualitative design was conducted and included open-ended interviews, observations, and textual analysis at two dental offices in the Richmond, Virginia, area.


© Stephanie J. Lau

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