Exploring a client journey from drug-health to oral-health services

Introduction: People with substance use disorder (SUD) have poor oral health (OH) compared to the general population. They have a high need for dental services, however due to medical and social reasons find accessing services challenging. Our case report examines an innovative integrated care approach. Case Description: In February 2023, Drug Health Services saw a 29-year-old Australian woman. The social worker assessed her OH using the new screening tool. She reported dental pain and had not seen a dentist in a year. The patient had a history of child protection, and familial child sexual abuse. She smoked Cannabis daily to self-manage anxiety, was unemployed, in social housing with three children under three years old and received government income support. She expressed significant dental anxiety due to her previous traumatic experiences.The social worker team referred the patient and provided a comprehensive handover to the dental team. An appointment was coordinated between the two services in consultation with the patient. Social worker accompanied her for emotional support and looked after her children. The dentist addressed immediate dental complaint and coordinated subsequent appointments with the assistance of the social worker and patient.In the post-appointment patient experience survey, she expressed feeling respected, consulted, involved in her care and gained confidence to attend future appointments. Discussion: Inclusion of OH screening in DHS and a coordinated referral process between the two services resulted in a positive patient experience and outcome. Conclusion/Clinical Significance: A model of integrated care with a multidisciplinary approach is needed to deliver sustainable positive outcomes for people with SUD

Clinicians’ perceptions of domestic violence routine screening in public dentistry

Aim or Purpose: To assess Sydney Dental Hospital (SDH) clinicians’ beliefs, attitudes, and experience in identification and response to domestic violence (DV) in a public dental setting prior to the implementation of Domestic Violence Routine Screening (DVRS). Materials and Methods: An anonymous cross-sectional survey was conducted amongst SDH clinicians from one general and two specialist clinics between November and December 2022 following completion of DVRS training and prior to DVRS implementation. The survey consisted of 10 questions addressing clinicians’ characteristics (demographic and educational history), their knowledge, perception, and previous experience responding to women disclosing DV. The study was approved by RPAH Ethics Committee. Results: Thirty-two clinicians participated (73% response), with 56% aged 25-34, 47% with more than 10 years of clinical experience (32% 5-10 years and 22% less 5 years) and 60% were general dentists. Most participants (75%) reported they had previously managed DV disclosures, and 63% agreed that responding to DV disclosure was part of their role, but 79% were not at all or only slightly confident in responding to DV disclosure prior to DVRS training. Nearly 60% considered that more training was needed, and their concerns included dealing with an ambiguous situation (95%), engaging with women to complete the screening (79%), responding to DV disclosures (79%) and child protection mandatory reporter requirements (63%). Conclusions: A large proportion of clinicians had previously managed DV disclosure prior to DVRS implementation and agreed that screening was part of their role but identified the need for more targeted training and support to increase their confidence in responding to DV and undertake DVRS

Caring for more than teeth

Aim or Purpose: To investigate dental clinician's perceptions regarding their role in identifying and understanding social and other health needs of vulnerable population seen in public dental services. Materials and Methods: An online anonymous cross-sectional survey was conducted over a period of 3 months between September and November 2022. The participants included all public dental clinicians working in Sydney Local Health District, Oral Health Service. The survey was designed to gauge the role of the dental clinician in identifying and understanding the social determinants of health that impact public dental patients. Likert-scaled questions were mostly utilised to determine how strongly participants held these personal beliefs and professional views regarding patients’ social and other health needs. The survey also included an open-ended question to allow participants to discuss any other aspects not covered in the questionnaire. The study was approved by the RPAH Ethics Committee. The findings were summarised using descriptive statistics. Results: The overall response rate was 42% (n=40) and all clinicians strongly agreed/agreed that patient's social risk factors impacted their oral health and ability to attend dental appointments. Despite, 88% strongly agreed/agreed that addressing patients’ non-dental needs fell within their professional responsibility, 70% strongly agreed/agreed that they were able to identify their patient's non-dental health and wellbeing needs. Only 30% strongly agreed/agreed that they had adequate training and resources and 32% were confident to refer their patients for non-dental health and wellbeing needs. Conclusions: Public dental clinicians identified the need for specific training to improve their knowledge and confidence to respond to their patients’ social and other health needs