PRIORITY ACCESS CARDS – HOMELESS CLIENTS

Train the TrainerResource for Oral Health Service providers

1 October 2014 – 31 January 2015

PURPOSE

This resource has been developed as part of a “train the trainer” package.

Coordinators for the Priority Access Cards at each of the 13 community oral health centres across the North and West metropolitan region will be able to use this resource in training staff at their centres

OVERVIEW

This resource provides information on • Homelessness & breaking down stereotypes• Purpose of the Priority Access Card Project

and homelessness• Project methodology• Understanding the roles of staff in oral health

services and project requirements• How to obtain assistance

HOMELESSNESS – some definitions

Being without the support network of family and friends generally expected in our society

Not having a roof over one’s head, or living in a rooming house, hotel or crisis accommodation

Receiving a low income, having few independent resources, being socially isolated and often having little prospect of self support

Levels of Homelessness - Primary

• People living in the streets, parks, squatting in derelict buildings, cars and railway carriages

Levels of Homelessness - Secondary

People who move from one shelter to another using emergencyaccommodation, refuges, relatives or friends

Levels of Homelessness - Tertiary

People who stay in boarding house accommodation, without security of tenure, and often without a separate bedroom or living room, and no kitchen

Example

Marginally Housed

• Those people living in caravans

• Families doubling up with relatives

• People in Office of Housing accommodation

Causes of Homelessness

• Family breakdown• Family violence/ abuse -

physical, sexual, emotional• Loss of social supports • Poverty/ unemployment• Lack of affordable housing• Disability (physical, cognitive or

psychiatric)• Alcohol and other drug use• Gambling

Duration

• We know from research both here and overseas that there is a direct correlation between the length of time spent experiencing homelessness and the subsequent severity of the impacts.

• Basically the longer a person is homeless the more damage it causes and the longer it takes to recover.

• Homelessness can have a devastating effect on children making their chances of experiencing homelessness later in life more likely.

Homelessness and Health• Poor dental health• Poor nutritional status• Eyesight problems• Lack of pain management and routine health

checks• Low compliance with and appropriate use of

medication• Recent data from ED presentations

84% substance abuse 70% serious medical issue 61% mental health issues 52% victims of attack

Barriers to dental services

• Dental services that do not have priority access protocols in place

• Time of appointments • Flexibility of booking appointment time that

also suits support worker• Support from management to assist dental

staff to understand homelessness and to prioritise

• Frontline staff understanding the criteria and the need to prioritise

Homelessness and Health Services

Health services ideally would:• Recognise rights and the unique needs of

homeless people• Provide accessible, equitable and high

standards of service• Acknowledge the need for a flexible response• Provide empowering and respectful service

acknowledging the rights of individuals• Be aware of the impact of homelessness

Homelessness & stereotypes

Misconception : They Are All Too Lazy to WorkMisconception: It is Always the Result of Poor ChoicesMisconception: It is Freedom and a Life of Leisure

Homelessness is a complicated issue. It is caused by a wide array of problems, many of which feed into each other.

Specifically what can we do??

We have an opportunity to improve access to oral health services for homeless people or people at risk of homelessness• Implementation of Phase Two of the Priority Access

Card 1st October 2014 to 31st January 2015• Purpose: Reimplementation of the Priority Access

Card. The card avoids the need for the homeless client to reveal their homeless status in a conversation when attending for a dental appointment

What is different to the previous Priority Access Card implementation (Phase One)

• Card is smaller (wallet sized, more durable)• Fewer distribution centres• 2 methods of distribution (active & passive) Active – Case Manager intervention

Passive – Client helps themselves

What is different to the previous Priority Access Card implementation (Phase One)

• Cards have unique identifiers• Project team to support implementation• Evaluation to be undertaken at the

completion of the project• Identifiers have been added to Titanium

database• Reports and feedback to all those involved

in Phase Two Implementation

Specifically, what can I do?

At every visit:• Be welcoming and accepting of people experiencing homelessness. • See beyond any difficult behaviour and work out sensitive ways to

manage such behaviour• Gauge whether the person is comfortable answering questions and

change or stagger your usual practice accordingly, entering “not known” if asking questions becomes awkward

• Using the “Titanium” database enter the unique identifier number of the Priority Access Card in the relevant field (preassigned in Titanium)

• Where the service protocol allows, waive the $25 co–payment fee or where collected organise details for reimbursement

• Provide follow up appointments as required• Be pleased to see the person again

Priority Access Card Project – coordinator role

The coordinator for this service is …(enter name)• Place posters in consulting rooms and waiting areas• Assist staff with any queries• Generate fortnightly reports from Titanium…screen snapshot

to come

• Send titanium reports to the project team• Speak weekly with a member of the project team• Display data from the project team on your

noticeboard• Talk about the data and issues at your service

meetings

Priority Access Card –What to do

Find the relevant item number in Titanium…screen snapshots following meeting with Colin

NEED HELP?

Please contact either Melissa Vonja on 9490 2700

mvonja@nmml.org.au

Deidre Watson on 9490 2723 dwatson@nmml.org.au

or visit

http://www.nmml.org.au/dental

Thank you

Thank you for participating and making a difference

Also much thanks to Julie Fry RDNS for Phase One Implementation, guidance in Phase Two and information presented in this resource