BAA has produced many reports and other written products for clients. Here is a sample of some of our more recent work.


Although the value of breastfeeding is well understood, there are many challenges that can make it difficult for women to start and continue breastfeeding. Funded programs show favorable results with initiation, but duration tends to be shorter than recommended. We surveyed nearly 600 women, most Hispanic, receiving services through family resource centers and other non-profits in Tulare County. We learned about their breastfeeding intentions and experiences, including knowledge about workplace breastfeeding rights, which we address in our recommendations.

To read the report, BREASTFEEDING IN TULARE COUNTY, click here to download (341KB pdf).

Home Visiting for Vulnerable Families

Home visiting serves an essential role in addressing the needs of young children by connecting families to programs and services. While every family with a young child may benefit from community and social support to help adjust to developmental stages and promote their child’s healthy development, for those with fewest assets, home visiting is a critical service to help families access supports and resources to help their child thrive. Home visiting—an integral part of the early childhood system of care—has been called “a lifeline for families during the COVID-19 pandemic.” We conducted a comprehensive Home Visiting Coordination (HVC) Needs Assessment for First 5 Tulare and its 17-member HVC Advisory Committee, funded as part of the First 5 CA HVC Initiative. The 78-page 2020-21 report contains the latest relevant community indicator data, findings from HVC partner agency surveys, feedback from key informant interviews, results from 415 parent survey respondents, and descriptions of 6 evidence-based and 5 other HV models. Goals, outcomes, conclusions and next steps are included, as are copies of the data collection tools we designed.

To read the report, HOME VISITING COORDINATION NEEDS ASSESSMENT, click here to download (1.7MB pdf).

Access to General Anesthesia for Dental Care

General anesthesia (GA) can be of great help to patients during dental treatments to relieve anxiety, prevent pain and ensure the safety of the procedure. For many children and adults with special needs, GA may be the only option for getting the dental care they need. Yet Sacramento hospitals and surgery centers—where GA is usually provided—restrict operating room time for dental cases, limiting access and causing long lag times to treatment. In addition to too little OR capacity, some managed care dental insurance companies serving Sacramento patients with Medi-Cal deny GA requests at high rates, a chronic problem that has not been satisfactorily addressed. Our study highlights the issues, provides new data to document the problem and offers 14 recommendations for improvement.


Dentists’ Experience Counseling for Tobacco Use and Sugar-Drink Consumption

There’s good evidence dental professionals can play an important role in promoting tobacco cessation and counseling families about over consumption of sugar-sweetened beverages. Time, lack of knowledge and confidence sometimes act as barriers. This report from Ventura County suggests dentists are willing to get more involved if they have training and materials.

To read the report, Tobacco Cessation and Sugar-Sweetened Beverage Counseling in Dental Offices, click here to download (256KB pdf).

Evaluation of Inmate Substance Abuse Treatment Program

What difference does it make to recidivism to offer substance abuse treatment programs to incarcerated men? This report presents evaluation findings from the Tulare County Sheriff’s Office FY 2019-2020 Residential Substance Abuse Treatment (RSAT) program, a successful project that has been in place for the past 18 years to address the county’s staggering drug problem and return inmates to the community with the necessary tools to remain clean and sober.

To read the report, Evaluation of the RSAT Program for Tulare County Sheriff Department, click here to download (738KB pdf).

Parent Survey

Where do parents get information when they have questions about caring for their young children? What community resources do they say they need most, how aware are they of services and to what extent do they use them? Feedback from the Parent Survey shares findings about these and other early childhood issues from an English/Spanish survey of 241 Tulare County parents receiving services through First 5. Learn more about nutrition practices, reading and TV habits and information and referrals parents have trouble finding that will inform grantmakers and community providers serving families with young children.

To read the report, Feedback from the 2016 Parent Survey, click here to download (846KB pdf).

Parent Attitudes and Children’s Use of Dental Services

What Parents are Saying About….Fear, Misconception and Other Barriers to Children’s Use of Dental Services shares findings from face-to-face interviews with 157 parents of young children about reasons for non-utilization/delayed utilization of dental services—a unique opportunity to learn more about barriers from the user side that will inform policymakers, funders, providers and other advocates of children’s dental care.

To read the report, What Parents are Saying About….Fear, Misconception and Other Barriers to Children’s Use of Dental Services, click here to download (639KB pdf).

Student Mental Health

This study examined the mental health needs and use of services among students preschool-college in Tulare and Kings Counties, California. Students, parents, teachers, school administrators, counselors and community mental health providers participated in interviews and surveys. The recommendations are a call to action for policymakers and advocates.

To read the final report, Tulare & Kings Counties Student Mental Health Needs Assessment, click here to download (21.6MB pdf). To read only the Executive Summary from this report, click here to download (9.3MB pdf).

Access to Dental Care

This 2022 comprehensive update to the Sacramento County Oral Health Needs Assessment—which uniquely includes links to testimonial videos—puts more of a focus on adults where dental care gets little attention and is often an overlooked aspect of overall health care. The importance of the report is introduced by county health officer, Dr. Olivia Kasirye. Among the key findings: Medical providers can play a critical role in promoting good oral health, but more than 50% of surveyed adults and 80% of focus group participants could not recall their doctor ever inquiring about their oral health. Less than 30% of patients received dental services within the same community clinic where they get their medical care. Fewer than one-quarter of adults with Medi-Cal utilized their annual dental benefits (between 17.7% and 23.7% among the dental managed care plans). Children’s utilization rose but remained lower than the statewide average, with dental sealants significantly under-delivered. The main barriers that emerged from this study were financial (no or limited coverage or ineligibility for Medi-Cal); negative prior dental experiences or worry a procedure would be painful; lack of awareness of existing coverage; lack of personal priority/follow-through; and lack of knowledge of how/where to access dental services. Pain—and enough of it for long enough—was “the big prompt” for many patients to seek care. Solving the problem of limited access to general anesthesia dentistry was the top recommendation of the Key Informants, who were frustrated by lack of enough progress. The report offers 17 detailed recommendations for improvement to the Medi-Cal Dental Advisory Committee.

To read the report, TEETH FOR A LIFETIME?, click here to download (3.1MB pdf).

California faces a continuing challenge of achieving and maintaining an adequate level of dentist participation in its Medicaid (Medi-Cal) dental program for children. We examined the extent of private practice dentist participation in 2012, the factors that account for their willingness to participate, and the challenges for increasing access to care. Quality and utilization issues were also examined. Denti-Cal claims data, a dentist survey, key informant interviews and existing research were used in the analysis.

To read the final report, Without Change it's the Same Old Drill, click here to download (676KB pdf).

Community Health Needs Assessment (Comprehensive)

One of the best ways to gain a better understanding about health needs, disparities, and available resources—and to meet the requirement of the Patient Protection and Affordable Care Act—is to conduct a comprehensive needs assessment. An important aspect of the community health needs assessment process is also obtaining information and views from community members themselves about which health-related needs are highest priority, and strategies to address them.

To view the results of our most recent Community Health Needs Assessment for a hospital collaborative and its strategic partners click here to download (3.4MB pdf).

Community Health Needs Assessment (Topic-Specific)

Sometimes a more limited community health needs assessment is all that is needed, such as to meet a funding requirement or to address a particular issue. We recently completed an extensive assessment for Altura Centers for Health concerning the need for reproductive health and family planning services.

To view our report, Tulare County 2021 Title X Family Planning Needs Assessment, click here to download (1.2MB pdf).

Dental Managed Care Studies

The most common and preventable disease of childhood is tooth decay, but access to dental services for many children remains "an elusive benefit," particularly for Sacramento County children according to our 2010 and 2015 studies of Geographic Dental Managed Care.

To read the report of the initial study, click here to download (676KB pdf).

To read the updated 2016 report, Sacramento Children and Dental Care: Better Off Than 5 Years Ago?, click here to download (1.7MB pdf).

Despite free dental coverage, fewer than 50% of California Medi-Cal managed care members utilized their dental benefits in 2014. To learn more about patient barriers and experience, read the key findings based on 849 completed surveys of 341 families with children and 508 adults in Sacramento and Los Angeles Counties.

To read the final report, Barriers to Utilization of Dental Benefits: Medi-Cal Dental Managed Care Member Survey, click here to download (708KB pdf).

Strategic Planning

Much has changed in the landscape of public health since COVID-19, requiring a robust public health system to protect the public’s health. A key component of the national Public Health Board re-accreditation process is having a thoughtful strategic plan. We facilitated a planning process and produced a new strategic plan for Butte County Public Health in 2022 that provided the department the opportunity for reflection about past achievements, examination of relevant data, assessment of current services and outcomes, and identification of strategic priorities. Organized around 6 strategic priorities, the plan applies a health equity lens to all public health programs and services.

To read the Butte County Public Health Strategic Plan, click here to download (749KB pdf).

In 2020, the First 5 Butte County Commission adopted a new 5-year Strategic Plan to guide its program investments in the future. The planning process took into account local needs assessment data and community perspectives as well as the declining nature of First 5 funds.

To read the 2021-2026 First 5 Butte County Strategic Plan, click here to download (749KB pdf).

Driven by the findings of the comprehensive oral health needs assessment we produced for Tulare County (along with assessments for Sacramento and Ventura counties), the OH Strategic Plan we developed gives direction to the County and its partners for improving oral health in Tulare County.

To read the Tulare County Oral Health Strategic Action Plan, click here to download (631KB pdf).

Effective planning begins with determining an organization's value proposition including its strengths and weaknesses and opportunities and threats (a SWOT analysis), and collecting key market and other data. Strategic business planning uses formats and processes to identify objectives and short- and long-term strategies and track progress of results.

To view a market assessment and strategic business plan developed for a statewide organization that summarized key organizational issues to manage change and achieve results, click here to download CINHC Market Assessment (377KB doc). click here to download CINHC Strategic Business Plan (651KB pdf).