PRIORITY ACCESS CARDS – HOMELESS CLIENTS Train the Trainer Resource 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 emergency accommodation, 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 Work Misconception: It is Always the Result of Poor Choices Misconception: 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 1 st October 2014 to 31 st 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 $26.50 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 – homeless service 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 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 & Titanium database Refer to the Titanium database training resource Part 1 : Data entry Part 2: Running reports from Titanium

NEED HELP? Please contact either Melissa Vonja on Deidre Watson on or visit

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