1. Smile4life programme: outcomes and future actions Andrea Rodriguez - Research Fellow, Smile4life programme Laura Beaton – Research Assistant, Smile4life programme Ruth Freeman – Co-Director of Dental Health Services Research Unit (DHSRU)

2. Smile4life The development, implementation and evaluation of a preventive oral health intervention for people experiencing homelessness in Scotland: promoting health and psycho-social wellbeing.

3. Specific objectives of the Smile4life programme 1.Working in partnership and promoting a knowledge of oral health and health needs 2.Conduct a needs assessment survey from the homeless client and from the professionals’ perspectives 3.Equip practitioners with the competencies and skills to promote oral health and psycho-social well-being for homeless people 4.Develop networks and team working strategies with organisations from Government, Third Sector and NHS Boards to strengthen public policy for homelessness

4. 2005: -An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland (The ‘Dental Action Plan’) -Health and Homeless Standards 2012: - National Oral Health Improvement Strategy for Priority Groups Background to Smile4life - Public Policy Context

5. Smile4life Survey - 2008-2009 The aim: to conduct an oral health and general needs assessment as the first stage of the programme Produced data on: -Demographic profile; -Health and health behaviours; -Degree of patient management complexity; -Psychosocial health http://dentistry.dundee.ac.uk/sites/dentistry.dundee.ac.uk/files/smile4life_report2011.pdf

6. Profile of the homeless sample 853 homeless people took part Demography  age range 16 to 78 years  largest age groups 16-24 years (29%) and 25-34 years (30%)  75% male  78% single Living status  32% living in hostels  20% in short-term temporary accommodation  7% in longer-term supported accommodation  2% rough sleepers Reasons for homelessness included relationship breakdown, substance misuse, eviction/loss of tenancy The group presented a diverse degrees of social exclusion and marginalisation: chaotic lifestyles

7. Health and health behaviours Major health problems – 22% asthma/lung disease – 18% bruise/bleed easily – 13% hypertension – 7% epilepsy – 7% heart disease – 3% diabetes – 11% HIV-positive or Hepatitis – C-positive Risk taking behaviours – 85% smoked tobacco (men stated that they smoked on average 20 cigarettes per day and women 15 cigarettes) – 30% drank alcohol daily – 29% used drugs – (81% of drug users IVDU)

8. Oral health status In this sample, 27% of decay experience was due to decayed (decay into dentine), 52% by missing teeth and 22% by filled teeth. This suggested that people had their decayed teeth extracted rather than filled.

9. Dental attendance pattern

10. Key findings …

11. Managing oral hygiene while homeless -Nowhere to go to brush the teeth -Other priorities in front of it -Dental attendance and registration -Preventive dental care -Dental anxiety

12. Psycho-social aspects Shame and fear of judgment “ the embarrassment, the mess of your teeth, and the longer it goes on the worse it gets…you’re embarrassed to go to the dentist because you’ve inflicted it on yourself” (F, 43) “when you fill the form in [at the dentist], you’ve got to put what medicines you’re taking. I’d say they would be judgemental, yes” (F, 32, methadone user)

13. Smile4life: Guide for Trainers (2012)

14. Smile4 life – Current Actions 1 - Partnership with NHS Education for Scotland: -Developing Training resources -Third Sector Links -Training days 2 - Partnership with Third Sector Organisations Mapping of key organisations from Third Sector working with Homelessness across Scotland Informal visits to know about their activities, outcomes and challenges in order to build integrated actions

15. Smile4life – Future Actions Increase the participation in networks of diverse organisations from Government, Third Sector and NHS Boards Survey from professionals working with people experiencing homelessness in the Third Sector to identify perceptions on health/oral health associated with their field of intervention and also to identify gaps and needs in their practices Systematization and dissemination of good practices and team work strategies to face homelessness from Third Sector Organisations and NHS Boards Identify and train oral health champions/peer educators from professional teams and user groups Provide training activities of Third Sector practitioners on issues that meet their needs Provide training and supervision of service users to improve users’ participation; health literacy; communication and life skills

16. Problems… …and solutions

17. Thank you! Contacts: a.rodriguez@dundee.ac.uk