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(No Transcript)
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Improving dental services for homeless
peopleSummary of findings from the exploratory
research project

• Health Social Care Integration Event
• Edinburgh
• 8th May 2014
• Stan Burridge

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A Pathway project
Funded by
London Housing Foundation
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• With funding from London Housing Foundation
  Pathway worked with the Eastman Dental Hospital,
  Groundswell UK, dentistry, homelessness service
  providers , as well as homeless, ex-homeless
  people to explore

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups
• What impact are those needs having on the
  individuals overall quality of life

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups
• What impact are those needs having on the
  individuals overall quality of life
• The importance of restorative dentistry and oral
  care to homeless people

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups
• What impact are those needs having on the
  individuals overall quality of life
• The importance of restorative dentistry and oral
  care to homeless people
• What experience homeless and ex-homeless have of
  receiving or accessing dental care

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups
• What impact are those needs having on the
  individuals overall quality of life
• The importance of restorative dentistry and oral
  care to homeless people
• What experience homeless and ex-homeless have of
  receiving or accessing dental care
• What potential difference treatment could make to
  an individuals recovery and life chances

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• Some of the practical issues which prevent
  homeless and ex-homeless people accessing dental
  treatment.
• We also looked at some of the attitude barriers
  (both by the patient and the practitioners) which
  impacts negatively on those accessing dental
  treatment
• What level of dental need there is within these
  groups
• What impact are those needs having on the
  individuals overall quality of life
• The importance of restorative dentistry and oral
  care to homeless people
• What experience homeless and ex-homeless have of
  receiving or accessing dental care
• What potential difference treatment could make to
  an individuals recovery and life chances
• And finally we continue to explore some
  practical ways to improve awareness of and access
  to quality dental advice and care

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Our working journey

• We began by conducting some peer-led research
  using a survey tool and with 149 current and
  former homeless people in a range of settings for
  example day-centres and drop-ins
• We then selected 14 of those to undergo a
  clinical assessment at Eastman Dental Hospital
• After that we have Supported and continue to
  support a small number of those patients in
  accessing a mainstream dentist to follow the
  treatment they were assessed as needing and
  gathering their experience
• We have continued having contact with a range of
  dentistry and homelessness service providers to
  explore barriers to treatment and options for
  change

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Survey respondents (n149)
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Percentages registered with dentist
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Reasons for not registering (n61)
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Barriers to registration (n23)
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Some findings about levels of need

• Dental pain was reported by more than one-third
  of the 149 people completing the survey and six
  of the fourteen people attending EDH
• Bleeding gums were reported by four in ten of the
  survey and EDH clinicians diagnosed gum disease
  in twelve of the 14 people they assessed
• Based on a standard quality of life screening
  tool, people involved in the research reported
  that dental problems impact fairly often or
  very often on their
• diet and nutrition (23 of survey respondents and
  57 of EDH clients)
• social interaction and confidence (32 of surveys
  and 64 of EDH clients) and/or
• general satisfaction with life (34 of survey
  respondents and 43 of EDH clients).

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Some of the barriers to access

• lack of clarity about entitlements and access
  options
• high levels of dental anxiety and previous bad
  experience
• inconstancies in what General Dental Practices
  and Community Dental Services are able to offer
  patients
• the impact of benefit changes on demonstrating
  eligibility and accessing treatment
• financial barriers faced by people on low pay
  requiring several stages of treatment, each
  requiring payment
• delays getting treatment, particularly for people
  needing to be treated in hospital dental services
  because of risk factors or complex needs
• limited coordination and understanding between
  community- and hospital-based services
• impact of substance misuse on treatment options
  some based on clinical concerns and/or
  assumptions

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Some good news, including

• the quality of treatment and support people
  received once they get access to services
• the positive impact of initial contact with
  understanding, non-judgemental, and caring
  dentist/s in overcoming high levels of dental
  anxiety and boosting patients confidence to seek
  help
• high levels of compliance with treatment,
  particularly when supported by a trusted staff
  member (eg. hostel key worker) or peer advocate
• powerful stories about the positive impact
  getting help with long-standing dental problems
  is having for individuals with poor previous
  experience and complex unmet needs.

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Next steps and opportunities for further
collaboration - will include

• continuing to support and learn from the journey
  through dental treatment of some of the EDH
  patients
• further investigating supply-side issues and
  constraints within General Dental Practice,
  Community Dentistry Services and Specialist
  Dental Services
• engaging a range of dentistry and homeless
  service providers to share our findings and
  consider their implications for practice and
  for policy-makers or commissioners
• raising awareness of rights to treatment and
  care, how to access it, and benefits of doing so
• building capacity to effectively support homeless
  people to access advice and treatment
• and your suggestions, please?

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Thank you.
www.pathway.org.uk stan.burridge_at_pathway.org.uk