Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

Abstract

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.

Evaluation of a community dental clinic providing care to people experiencing homelessness: A mixed methods approach

“…We found that 42 out of 89 (47%) of patients had completed a treatment plan, while 27% failed to return for treatment completion. In contrast, previous research evaluating services for people experiencing homelessness 7,9,16,21 demonstrated lower levels of attendance and completion. A review of 204 patients attending a targeted dental service in London from 1992 to 2001, indicated that only 18% completed their treatment 7 .…”

“…A review of 204 patients attending a targeted dental service in London from 1992 to 2001, indicated that only 18% completed their treatment 7 . A community clinic in Australia providing dental care to young people experiencing homelessness had a high percentage of failure‐to‐attend (57%) pre‐booked appointments 21 . A unique feature of the care pathway developed by PDSE, and found to be crucial for the success of the clinic, is the role of a link worker.…”

“…Despite the acknowledged importance of such clinics, research exploring their impact and/or effectiveness has been limited, and mostly descriptive or quantitative. An important missing element is exploration of care models and processes that support or inhibit the delivery and use of dental clinics for individuals experiencing homelessness 7,9,21 …”

Oral health perceptions and client satisfaction among homeless adults attending a community‐centred dental clinic

“…[2][3][4][5] To improve uptake and utilization by disadvantaged groups, past research recommends that dental services become more targeted, community-centred and integrated into broader primary models of care such as homeless health care programs. 2,16,[20][21][22] Communitycentred dental clinic (CDC) care is one approach attempting to provide more targeted and accessible care to disadvantaged groups. 10,13,22 CDCs generally rely on a combination of government support and community donations, operating as not-for-profit clinics integrated within broader community health centres or as mobile services delivering outreach programs.…”

“…25 They are a likely reflection of higher rates of untreated oral disease and lower access to dental care commonly experienced by disadvantaged groups. [2][3][4][5][6]14,20,25 A similar study by Daly et al 5 proposed that greater sensitivities to oral health impacts by the homeless are due to its heightened importance in the experience of disadvantage. The importance of dental appearance for selfconfidence, social functioning and levels of esteem in the experience of disadvantage is reported in the literature.…”