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

Abstract

Background People who experience homelessness have higher dental treatment needs compared to the general population. However, their utilization of dental services and levels of treatment completion are low. Peninsula Dental Social Enterprise, a not‐for‐profit organization in the United Kingdom, established a community dental clinic to improve access to dental care for this population. Objectives To evaluate the impact and acceptability of the community dental service for patients and examine the barriers and enablers to using and providing the service. Methods The evaluation included a retrospective assessment of anonymous patient data and thematic analysis of semi‐structured interviews with patients, support staff and service providers. The interviews were thematically analysed. A cost analysis of the dental service was also conducted. Results By 18 February 2020, 89 patients had attended the clinic. These included 62 males (70%) and 27 females (30%), aged 38.43 years on average (SD ± 11.07). Of these, 42 (47%) patients have completed their treatment, 23 (26%) are in active treatment and 24 (27%) left treatment. In total, 684 appointments (541.5 hours clinical time) were given. Of these, 82% (562) of appointments were attended (452.5 hours clinical time). The 22 interviews that were conducted identified flexibility, close collaboration with support services and health‐care team attitudes as key factors influencing service utilization and continuity of care. Conclusions This study provides details of a highly acceptable and accessible dental care model for people experiencing homelessness, with recommendations at research, practice and commissioning levels.

Improving access to oral healthcare for people experiencing homelessness is good for public health

“…There is information available in the United Kingdom to help in the design of dental services for people experiencing homelessness and a common set of enablers are emerging. 8–11 Outreach and community engagement can often help to break down barriers to care by meeting people in their own environment, and this can help to de-stigmatise the view of healthcare professionals and build positive relationships that are based on trust. 11 The importance of community engagement is also increasingly recognised in healthcare education.…”

The benefits of an innovative community engagement model in dental undergraduate education

“…Target organisations may include organisations supporting vulnerable population groups such as the Salvation Army, British Red Cross, Age UK, housing associations and charities, or focus on families and children through support services such as the Family Nurse Partnership or in Early Year's education settings. Student-led projects often act as pilot projects which are used to support new community programmes and/ or applications for external funding to address gaps in oral healthcare identified through their engagement, and a number of successful services have grown out of student activity [10][11][12] thus creating projects and programmes, which benefit communities in the longer term. A rolling programme of evaluation and research sits alongside the student activity and which aims to evaluate the impact, particularly focused on improvements in access to oral healthcare for socially excluded groups, a key measure of success for community engagement.…”

“…One such example is the establishment of a dedicated dental service for people experiencing homelessness, which was initially developed by dental students through their work to highlight the stark oral health needs in this group in the locality. Evaluation of the de novo service has demonstrated a mutual benefit to patients and students alike, with a transformational effect on many patients' lives [12] and positive benefits to students through improved awareness, confidence and attitudinal changes towards people experiencing homelessness [11].…”

Kiwi frustration

“…The model has demonstrated an effective approach that can improve access to care in a way that is acceptable to patients and to dental professionals and is an active part of the dental curriculum. 3 Integrating homelessness in the dental curriculum can bring about positive changes in the way dental health professionals work with vulnerable groups in the community. The treatment provided can in turn act as a…”