Disclosure of Commercial Support

Presenter Disclosure Presenter: Haidar Farran, Oral Health Coordinator Hamilton Urban Core CHC Relationships with commercial interests: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: None

CFPC Conflict of Interest

Effective Outreach to Promote Health Programs to Low Income Families:

Lessons learned from community and public oral health programs

Haidar Farran DMD Oral Health Coordinator

Hamilton Urban Core CHC For AOHC’s 2014 Annual Conference “PREVENT MORE TO TREAT LESS. Public Health and Primary Health Care TOGETHER.” TORONTO

Introduction

• Hamilton Urban Core is committed to reaching out to vulnerable and marginalized groups in order to meet their needs, and to support them in accessing services that will improve their oral health and general wellbeing

• As a community/people-centered agency we recognize the need to deliver primary health care services directly to clients by taking those services to them

• Outreach strategies emerge as a way to extend those

needed services, and help build mutual trust and honest relationships with our community through accessible venues and direct dialogue

Community in Profile: Hamilton • In 2006, 504,559 people lived in Hamilton

– (4.1% of Ontario Population) • Slower population growth

– 2001-2006 2.8% versus Ontario average 6.6% • Higher Proportion of Seniors

– As of 2006, 14.9% of Hamilton residents were Seniors vs. Ontario overall 13.6% • Higher proportion of low income residents

– A larger proportion of Hamilton families are in the low income category (14.3% compared to 11.7% in Ontario)

Source: Ontario Trillium Foundation: Your Community in Profile 2008

• Increasing diversity – Hamilton is one of the most diverse cities in Canada and the second largest new

immigrant arrival city in Ontario, next to Toronto – Approximately 40% of the population indicate that they were born outside of

Canada – There are more than 52 main language groups represented in the Hamilton area – English is not their first language, as such they may experience difficulty

accessing primary health care and other social services due to language barriers Source: Social Planning and Research Council

Highlights of Hamilton Urban Core CHC

• The Hamilton Urban Core Community Health Centre was founded in 1996

• We are an inner city health centre located in the core of the downtown Hamilton

• A large percentage of our registered clients are individuals and families with low or no income; living in poverty; under-housed; at imminent risk of homelessness; homeless; street involved youth and isolated seniors

• A large percentage of our clients are immigrants and refugees

• We provide culturally sensitive programs and services in more than 15 languages to priority populations through our interprets team

• Our Staff speak 21 different languages

• Our Oral Health Program had encountered 12,497 encountering

Hamilton Urban Core

Oral Health Program Focus Areas

• In the context of Primary Health Care we deliver quality, client-centered, inclusive and appropriate services, that focus on the most disadvantaged and in-need populations

Oral Health Care

• Enables individuals to have control over factors that affect oral wellbeing; education; awareness of services; ensures accessible oral healthcare; enhances lobbying abilities

Oral Health Promotion

• Delivery of services that aim to slow and stop oral health problems, and maintain good levels of oral and general wellbeing

Oral Disease Prevention

• Enhances skills; increases abilities and awareness of entitlements and benefits; increases confidence and motivation to engage in self care

Community Capacity Building

• Ensures the integration of our services with the delivery of other oral health programs and services; appropriate internal and external referrals; advocacy

Service Integration

• Hard-to-reach targets: marginalized and isolated populations, people facing barriers, immigrants and refugees, homeless/at risk of being homeless and low income families

Outreach

Outreach Definition

• “An intervention/activity generally conducted by outreach workers, peer educators, and/or health educators, out on the streets and within the community, face-to-face, with target groups who are at risk for oral disease like homeless, low incomes, refugees, immigrants, seniors etc.”

Source: Centres for Disease Control

• “Any point of contact is a point of service.” Source: Hamilton Urban Core Service Delivery Philosophy Statement

Know Your Target Population!

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OUTREACH

Is the program/service relevant, & needed for target population?

Where could you find them?

Who do you want to reach?

Techniques of Outreach

Face-to-Face

Info. Fair Display Boards

Outreach Education

Flyer Brochure

Poster

Phone Calls

Mail & Email

Mass Media, Articles

Social Media

Info. & Resources

Clinic

Guest Speaker

Other Media

OUTREACH

Out on Street & in Community

Importance of Outreach

Outreach Helps: • Develop a relationship between our centres and the

community (target groups) • Us know our community, their needs and interests • Generate community awareness: Why do we exist? Where

are we located? And what services we provide? • Convey a credible, positive image of our centres to the

community • Bring our centres closer to the community and the

community closer to us • Promote networking and collaboration between our centres

and future partnering organizations • Demonstrate our willingness to go to the community rather

than wait for the community to come to us

Examples of Face-to-Face Outreach

One-on-One

Setting

Information &

Resources Clinics

Home and Shelter

Outreach Visits

Mobile Clinics: Dental Health Bus,

Portable Oral

Health Units

Health Street Fairs

Group Setting

Presentation

Blocks of Effective Outreach: Face-to-Face Approach

Build mutual trust: recognize and value the great diversity & differences of target groups

Messages and written info are: appropriate, sensitive, friendly & easy to understand

Language: provide Information in client’s primary language

Messaging: non threatening to beliefs, interests & dignity

Follow-up…….! Follow-up…….! Follow-up…….! Follow-up…….! Follow-up…….!

Be patient: 1st may ignore 2nd they hear it and give it a little thought 3rd will give it real consideration.

Know your community: listen carefully to opinions, and assess needs and interests

Offer services: lodging homes, schools, libraries, home visits, drop-in centres

Timing: at a convenient time for the target population

Meet people where they are (e.g. on street, in the community)

Significance of Face-to-Face Outreach • Promotes direct engagement and initiates lively dialogue

with target population • When people communicate directly, they are able to

make human connections and develop trust/rapport • Overcomes language barriers and allows for better and

clearer understanding about your organizational message, and the needs of the target population

• Demonstrates to which extent we are eager, sincere and compassionate to serve

• Is a strong vehicle to provide instant and substantial assistance, information, social and emotional support

• Phone calls, postings, emails, mail, advertising and social media aren't likely to produce the same impact as a single conversation

Oral Health Partners & Collaborative Networks

• Agencies serving immigrants and refugees • CCE Learning Centres (ESL, LINC) • Public libraries • St. Charles Adult Learning Centres • Seniors associations and programs • Lodging homes • Shelters • Private sector – oral healthcare services (dentists,

denturists) • Non-profit & charitable agencies • Clients groups, ethnic and cultural associations

HIPHOP Project

• Stands for “Health Interventions to Preventing Homelessness of Older Persons”

• Partnership project

• Outreach services

• Oral health care, chiropody, primary health care and housing services

• Target population: 55 years+

• Funded by HPI (Homelessness Partnership Initiative)

Who is Involved?

VON Hamilton St. Matthew’s House

Hamilton Urban Core CHC

Benefits of Partnerships

• Pooling of resources • Improved understanding of diverse client needs • Coordinated efforts • Integrated service delivery • Access to additional financial and human resources • Access to a greater area of expertise • Enhance centre’s image and standing • Build up a wider base of support • Better organizational positioning by “power of association”

Breaking Down the Barriers to Outreach and/or Services • 52 main language groups, English is not first language • 40% born outside Canada Interpreters, Translators Language

• Stereotyping, judgemental, unapproachable, unfriendly • Discourages participation in activities Provider’s Attitude

• Culture and health behaviour clash • Cultural competency training Cultural Differences

• Time is convenient for the target population • Flexible hours Time

• Client is on his/her own to come for appointments • Provide bus tickets or taxi vouchers Transportation

• Home visits • Place of meeting wheel chair accessible, lift, auto. door Physical Abilities

• No insurance and a lack of free or affordable services • Advocacy, appropriate referral, liaison Financial Hardship

• Lack of knowledge about available services • Cannot take advantage of available services

Awareness of Services (Flow of Info)

• Decreases participation and access to services • Easy process: increases chances to engage clients Complication of Process

FACI L I TATE OR I MPEDE

Community Outreach Education

• “Educational programs directed to the general public that attempt to improve, maintain, and safeguard the oral health of the community.”

Source: Mosby's Medical, Nursing & Allied Health Dictionary, The C.V. Mosby Company, 1990.

• Provided outreach education for 26,069 persons (June 1998-March 2014)

Karen Community Oral Health Day

Community Oral Health Messages

• “All individuals, families and groups have the right to access basic oral health services which is important to attaining optimum state of oral health and oral well-being.”

Source: adapted from World Health Organization Community Health Day Messages

• All people have a right to be treated with dignity and respect

• People have a right to barrier-free information, resources, services and programs that keep people well and healthy

• People have a right to communicate in their chosen language

Information & Resources Outreach Clinic Mandate

• The Oral Health Information and Resources Clinic is committed to reach out, to educate and provide information about oral health programs, services and resources within the city of Hamilton that are available to serve and meet the basic oral health needs of marginalized and underserved groups.

Helping Hands Street Mission Outreach Clinic

Information & Resources Outreach Clinic Goals & Objectives

The Oral Health Information and Resources Clinic aims to: • Provide appropriate, reliable, efficient and resourceful oral

health information to the target population and help assist them to access and use those services barrier-free

• Raise awareness of target population about importance of oral health to general wellbeing and quality of life

• Promote and ensure that target population understand their oral health entitlement and benefits

• Eliminate barriers to accessing information, knowledge,

services and programs that keep people well and healthy

Impact of Information & Resources Clinics: Barton Branch-Hamilton Public Library

• “I hear you made a great impact at Barton Library last night. Thank you so much for sharing information on oral health. I’m so glad you were able to spend some time at the branch. Perhaps this is something we could look at doing more often. I’m not sure a “program” would work, but by the sounds of it, what you did last night was a good fit for this neighbourhood.”

Drop-in Centres Shelters Food Banks Libraries Social Services - Ontario Works ESL/LINC Classes CCE Learning Centres Settlement Agencies Religious Institutions Partner Agencies that serve target population And/or any place where you might reach your target population

Where to Set Up Clinics

Lessons Learned: Community Oral Health Perspective

• The basic principle of outreach is to reach out to where the client is: shelters, drop-in centres, partner agencies, outside on the streets and anywhere in the community

• Outreach ensures the availability of barrier-free oral health care for communities who need it, at the right time, and in a place convenient to their existence and physical abilities

• To respond to diverse clients, agencies should be culturally sensitive and competent to act and comply to the needs with an appropriate, responsive and respectful approach

• People have a right to communicate in their chosen language

• Establishment of multi-agency partnerships achieves pooling of resources and expertise, ensures wider base of support and better organizational positioning

Recommendations

We call on/for: • AOHC/CHCs to advocate for the inclusion of POHC as a core

component of the PHC services package

• Establishment of community oral health programs which are extremely effective at improving oral health and would have greater impact on the oral health of marginalized communities

• The extension of the oral health package from emergency services to basic services so it includes: all preventive services and root canal treatment for incisors, canines and all premolars in order to keep minimal functional dentition

• Balanced and effective working relationship between public and community health programs based on equal partnership

• Primary health care providers to include oral health initial assessment to the routine health examination and to advise/make referrals as needed

• Considering the power of face-to-face outreach and the impact and influence it can have on target populations