1. An Oral Health Needs Assessment of Prisoners in HMP Brixton Ellie Heidari Senior Clinical Teacher Sedation & Special Care Dentistry King’s College London

2. Key areas Health Needs Assessment The Oral Health Needs Assessment Outcome of the OHNA

3. What is Health Needs Assessment? A systematic method which identifies unmet health and healthcare needs of a population Source: Wright J, Williams R& Wilkinson J BMJ 1998;316:1310-1313 (25 April)

4. Why is HNA important? ‘The purpose of needs assessment in health care is to gather the information required to bring about change beneficial to the health of the population.’

5. Why has HNA become important? Inequalities Limitation of resources Prioritisation with resources Expectations

6. The OHNA development Expressed needs Normative needs

7. The Oral Health Needs Assessment’s aim To investigate the oral health status and dental treatment requirements of prisoners in HMP Brixton.

8. Permission & Ethical approval Local Research Ethics Committee Northern and Yorkshire Multi-Centre Research Ethics Committee (MREC) Committee’s location The committee’s members

9. Problems during the pilot study 1. Forms – Not returned – Were missing because prisoners had been released, bailed or transferred. 2. No dental treatment - no participation Outcome: Convenience sample

10. Results Demography Young population Social classes IV, V High unemployment rate

11. Results Poor General Health Depression & mental illnesses Smokers, alcohol/drug dependency Poor Oral Health Attitude lack of perceived needs especially before imprisonment Dental attendance, preference, treatment Barriers (apathy, anxiety) Emergency rx & pain control

12. Factors affecting oral health 1) Unhealthy behaviours Drug use Alcohol consumption Tobacco smoking Sugar consumption 2) Low use of dental services Dental anxiety Priorities 3) Attitudes of dental care professionals 4) Low use of preventive oral health services

13. Oral Health Promotion (before OHNA) “Single approach” Advice on - Smoking cessation - Alcohol consumption - Recreational drugs - Diet/calorie intake Craving Mixer

14. Oral Health Promotion (after OHNA) “Whole team approach” Liaised with the medical team Prison smoking cessation programme Pharmacist The canteen shop

15. Oral Health Promotion Constraints Mobile, shortage/lack of staff - Dental Care Professional Source: Dyer & Robinson 2006 - Prison staff Lack of training to undertake health intervention Mobile prison population Insufficient funding Time Difficulties to evaluate

16. To consider A standardised HNA Encourage oral health promotion Motivate/maintain/value Change health/oral health related behaviour Funding/resources To increase provision of dental services To perform research/audit To improve toothbrush/paste Interprofessional integration Identify the most vulnerable group Pain/infection control Staff support network Clinical governance Follow up in community

17. Thank you for your time and attention