refugee and asylum seeker oral health recall tool...

Lauren Tyrrell Toni Mansfield

Sue Casey

JUNE 2017

Refugee and Asylum Seeker

Oral Health Recall Tool

Development and Pilot

F I N A L R E P O R T

Refugee and Asylum Seeker Oral Health Recall Tool – Development and Pilot

First published 2017

The Victorian Foundation for Survivors of Torture Inc. (Foundation House) 4 Gardiner Street, Brunswick Victoria 3056, Australia

Email: [email protected]

Web: www.refugeehealthnetwork.org.au

ISBN Printed: ISBN-13: 978-0-9945276-4-6

ISBN electronic: ISBN-13: 978-0-9945276-5-3

Copyright © 2017 The Victorian Foundation for Survivors of Torture Inc. (Foundation House)

The Victorian Refugee Health Network promotes the sharing of information, and the use, reproduction, and dissemination of this report is encouraged.

To protect the integrity of the material, please note the following conditions apply:• Any part of this report may be reproduced or quoted,

provided the source and author are acknowledged.• The report may not be reproduced for commercial

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permission. However, requests to adapt material for particular purposes, for example to translate it into another language, are welcome.

If you have queries about the use of this material please contact us at [email protected]

Copy editing by Neil Conning Layout by Mark Carter

Cover photos: © Dental Health Services Victoria

The best efforts have been made to ensure the accuracy of the information presented in this publication as at June 2017. However, the Victorian Foundation for Survivors of Torture cannot be held responsible for any consequences arising from the use of information contained in this publication

Suggested citation

Tyrrell, L., Mansfield, T., & Casey, S., 2017, Refugee and Asylum Seeker Oral Health Recall Tool – Development and Pilot: Final Report, Victorian Refugee Health Network: Melbourne.

mailto:[email protected]

http://www.refugeehealthnetwork.org.au

mailto:[email protected]

Refugee and Asylum Seeker Oral Health Recall Tool – Development and Pilot 1

Contents

Executive summary 2

Acknowledgements 3

Introduction 4Background 4Rationalefortheproject 4Projectobjectives 5Projectphases 5

Literature review 6Refugeeoralhealthandaccesstodentalcare 6Factorsassociatedwithpoororalhealth 6Competingsettlementdemands 7Fearandlackoftrust 7Languagebarriers 7Loworalhealthserviceliteracy 7Loworalhealthliteracy 7Dietarychanges 8

Project Advisory Group 9Stakeholderinterviews 9Communityadvice 10FirstProjectAdvisoryGroupmeeting 10SecondProjectAdvisoryGroupmeeting 11

Refugee and Asylum Seeker Oral Health Recall Tool 12

Piloting of the tool 13Purpose 13Pilotsites 13Pilotoverview 13

Findings and discussion 14Thresholdforoverallhigherriskrating 14Useracceptabilityandcongruencewithworkflow 15Theclientexperience 15

Recommendations 16

References 17

Appendix: Refugee and Asylum Seeker Oral Health Recall Tool 19

Refugee and Asylum Seeker Oral Health Recall Tool – Development and Pilot2

Executive summary

RECOMMENDATION 1

DHSVfacilitateatrialoftheRefugeeandAsylumSeekerOralHealthRecallToolacrossalargernumberofservicesacrossthestatetoassessthevalidityandinter-raterreliabilityofthetool.Thisshouldincludedemographicdatatounderstanddifferencesacrosscohorts.

RECOMMENDATION 2

Dentalservicesparticipatinginthetrialconsiderimplementingasix-monthrecallperiodforclientsidentifiedashigherrisk,subjecttoaDHSVreviewoftheevidenceforasix-monthrecall.

RECOMMENDATION 3

DHSVconsidertheevidencefromtheMonashHealthSocialRiskAssessmentresearchprojectinthedevelopmentofafinalversionoftheRefugeeandAsylumSeekerOralHealthRecallTool.

RECOMMENDATION 4

DHSVsupportagenciestoadoptandimplementtheRefugeeandAsylumSeekerOralHealthRecallToolbyfacilitatingprofessionaldevelopmentaboutrefugeeandasylumseekerexperiences(inpartnershipwithFoundationHouse),theModelofCare,andthetool.

RECOMMENDATION 5

DHSVembedtheRefugeeandAsylumSeekerOralHealthRecallToolinTitaniumtofacilitateitsuptakeandusability.

RECOMMENDATION 6

DentalservicesimplementingtheRefugeeandAsylumSeekerOralHealthRecallTooldevelopandutilisereferralpathwayswithintheircommunityhealthservicetosupportclientsforwhomhighrisksareidentified.

RECOMMENDATION 7

DHSVutilisethefindingsfromabroadertrialoftheRefugeeandAsylumSeekerOralHealthRecallTooltoinformfurtherdevelopmentoftheModelofCareforRefugeeandAsylumSeekerOralHealth.

A Refugee and Asylum Seeker Oral Health Recall Tool (see Appendix) has been developed for use in Victorian public dental services. This report details the process and findings of the development and piloting of this tool. The project was funded by Dental Health Services Victoria (DHSV) and conducted over a five-month period from November 2016 to April 2017 by the Victorian Refugee Health Network.

Thedevelopmentofthetoolwasinformedbyaliteraturereview,theProjectAdvisoryGroup,FoundationHousecommunityliaisonworkers,anddentalserviceswhoparticipatedinthepilot.Thefactorsassociatedwithpoororalhealthwithinrefugeeandasylumseekerpopulationsareuniqueandcomplex,withoveralloralhealthandsubsequentaccesstoservicesimpactedbybothpre-arrivalandresettlementfactors.Thisincludesfactorssuchaspre-arrivaltortureandtrauma(includingtraumatothemouth/teeth),thehealthimpactofperiodsofdeprivationintransit,andtheongoingsystemicandsocialdisadvantagesrelatedtoresettlement,includinglanguagebarriersandunfamiliaritywiththeAustralianhealthsystem.

In2010,theVictorianDepartmentofHealthimplementedtwopoliciesinregardtooralhealth;itidentifiedrefugeesandasylumseekersasapriorityaccessgroupandprovidedafeeexemptionatpublicdentalservicesacrossVictoria.Subsequently,the2012RefugeeOralHealthSectorCapacityBuildingProject(inclusiveofModelofCare)aimedtosupportpublicdentalservicesinVictoriatoimplementthepriorityaccessandfeeexemptionpoliciesandworkwithpeoplefromrefugeebackgrounds.TheModelofCarerecommendsobservationandassessmentofsocialandclinicalriskfactorsthatimpactonoralhealthcareasthebasisforcontinuedpriorityaccessforindividualsfromrefugeebackgrounds.

Peoplefromrefugeebackgroundspresentwithvaryingdegreesofriskofpoororalhealth.Forthisreasonoralhealthpractitionersrequireanapproachthatdifferentiatespeoplethatrequireongoingsupporttoaccessservicesfromthosewhomayjoingeneralwaitlists.Thedevelopmentofthisevidence-basedtoolsupportsoralhealthpractitionerstomakethesedecisions.

BasedontheadviceprovidedbytheProjectAdvisoryGroupandthefindingsfromthepilot,theVictorianRefugeeHealthNetworkhasmadesevenrecommendations.


Acknowledgements

TheVictorianRefugeeHealthNetworkwouldliketothankthemembersoftheProjectAdvisoryGroupwhoprovidedvaluableexpertadviceandsupportforthisprojectduringtheProjectAdvisoryGroupmeetingsand/orstakeholderinterviews:• DrColinRileyDental Health Services Victoria• JenniBakerDental Health Services Victoria• RobynAlexanderDental Health Services Victoria• SueCaseyFoundation House• DrRaminiShankumarMonash Health• DrParulMarwahaMonash Health• AlanaRussoMonash Health• GemmaKennedycohealth• DrVinithaSoosaipillaicohealth• DrMichaelSmithBarwon Health• SharonSharpBarwon Health• SonyaHowardBarwon Health• DrSachidanandRajuDianella Community Health• AngelaBlackDianella Community Health• DrShibuMathewPlenty Valley Community Health• CarmelAlianoPlenty Valley Community Health• DrMartinHallNorth Richmond Community Health and

Dental Health Services Victoria• DrEmilyChalmers-RobertsonNorth Richmond

Community Health and Dental Health Services Victoria• DrJohnRogersDepartment of Health and Human

Services• DrAnilRaichurDepartment of Health and Human

Services• DrElishaRiggsMurdoch Children’s Research Institute

ThankyoutoGemmaKennedyandtheoralhealthteamatcohealthKensington,andSonyaHowardandtheoralhealthteamatBarwonHealthCorioforpilotingthetoolattheirservices.

ThankyoutothecommunitycapacitybuildingteamatFoundationHousefortheirreflectionsonhowmembersoftheircommunitiesmayexperiencethetool:SalamDankha,AndrewKalon,DinaKorkees,MuruMurukaverl,NajlaNaier,KifarkisNissan,ReginaldShwe,SusieStrehlowandChitluWyn.

ThankyoutoEllaPerlowfromtheUniversityofMelbourneforherassistancewithconductingtheliteraturereview.


Introduction

This report documents the process and findings of a project aimed at developing and piloting a Refugee and Asylum Seeker Oral Health Recall Tool for use in Victorian public dental services. The project was funded by Dental Health Services Victoria (DHSV) and conducted over a five-month period from November 2016 to April 2017 by the Victorian Refugee Health Network.

BackgroundIn2010,theVictorianDepartmentofHealthimplementedtwopoliciestoprovidegreateraccesstooralhealthservicesforpeoplefromrefugeeandasylumseekerbackgrounds.Thesepoliciesidentifiedrefugeesandasylumseekersasapriorityaccessgroup(StateGovernmentofVictoriaDepartmentofHealth,2014a)andprovidedafeeexemptionatpublicdentalhealthservicesacrossthestate(StateGovernmentofVictoriaDepartmentofHealth,2014b).Asapriorityaccessgroup,peoplefromrefugeebackgroundsareeligibleforthenextavailableappointmentforgeneralcareandshouldnotbeplacedonthewaitlist.

The2012RefugeeOralHealthSectorCapacityBuildingProjectwasacollaborativeprojectfundedbytheVictorianDepartmentofHealthandundertakenbytheVictorianRefugeeHealthNetworkinpartnershipwithDHSV,tosupportVictorianpublicdentalservicestoimplementthepriorityaccessandfeeexemptionpoliciesandtoworkeffectivelywithclientsfromrefugeebackgrounds.KeyoutcomesoftheprojectincludedthedevelopmentofaModel of Care for Refugee and Asylum Seeker Oral Health,complementaryfactsheetsonIdentifying clients of refugee & asylum seeker backgroundandWorking with refugee & asylum seeker clients,andthedevelopmentanddeliveryofatargetededucationprogramforpublicdentalservices.

TheModelofCarerecommendsobservationandassessmentofclinicalandsocialriskfactorsasthebasisforcontinuedpriorityaccessforindividualsfromrefugeebackgrounds.Theserecommendationsencourageclinicalstafftoobserveandassessclientsforclinicalandsocialrisksthatmayimpactontheclient’soralhealthcareandabilitytorenegotiatecomplexappointmentsystemsforfollow-upcare;and,basedonthisassessment,tosetupadultrecallappointmentsandconsideroralhealtheducationforhigh-riskclients.TheModelofCarerecommendsthatclientsidentifiedaslowriskmaybeplacedonthegeneralwaitlist.Services

participatinginthetargetededucationprogramidentifiedaneedforatooltosupportthemtoassesssocialandclinicaloralhealthrisksforpeoplefromrefugeebackgroundsandimplementtheModelofCare.

RationalefortheprojectTheAustralianRefugeeandHumanitarianProgrammeresettles13,750peopleannually.Itisestimatedthataround4,000newarrivalssettleinVictoriaeachyear,with10–15percentoftheseinruralandregionalareas.Anotherapproximately9,000peoplewhoareseekingasylumarelivinginthecommunityinVictoriaonbridgingvisaswhiletheywaitforthedeterminationoftheirrefugeestatus(StateGovernmentofVictoriaDepartmentofHealth,2014c).In2016–17thenumberofpeoplesettlinginVictoriaincreasedduetoanadditional12,000humanitarianprogramplacesmadeavailableforpeopleescapingconflictsinSyriaandIraqin2015(AustralianGovernmentDepartmentofImmigrationandBorderProtection,2016b).Thereareplannedincreasestothesizeofthehumanitarianprogramintakeby2018–19(AustralianGovernmentDepartmentofImmigrationandBorderProtection,2016a).

Peoplefromrefugeebackgroundshavevariedcapacitytoidentifytheneedandself-advocatefororalhealthcare.Forthisreason,oralhealthpractitionersrequireanapproachthatdifferentiatespeoplethatrequireongoingsupporttoaccessservicesfromthosethatmaybeabletonegotiatetheirowncareaftertheirinitialcourseoftreatment.Thedevelopmentofanevidence-basedtoolwouldsupportoralhealthpractitionerstomakethesedecisions.


ProjectobjectivesTodevelopandpilotastate-wide,evidence-basedtoolforusebystaffinVictorianpublicdentalservicesduringthefirstcourseofcareforanadultrefugeeorasylumseekerclientto:

1. Assesssocialandclinicalrisksthatmayimpactupontheir:

— oralhealthstatus— abilitytomanagetheirownoralhealth— abilitytoengageinfuturetreatment.

2. Recommendevidence-basedcoursesofaction.

3. Helpdetermine:— iftheclientneedstoberecalledtotheservicefortheirnextappointment,or

— iftheycangoonthegeneralwaitlist.

ProjectphasesTheprojectwasconductedinthreephases:• Initial scoping:included:

— areviewoftheacademicliteratureonsocialandclinicalhealthissuesthatleadtopoororalhealthoutcomesanddecreasedaccesstooralhealthcareforpeoplefromrefugeebackgrounds;

— consultationwithkeyoralhealthstakeholderstounderstandtheservicecontextandcurrentpracticeinpublicdentalservicesinareasofhighrefugeesettlementacrossthestate,andscopeservices’viewsandrequirementsaboutthetool;and

— consultationwithcommunityliaisonworkersatFoundationHousefortheiradviceonhowrefugee-backgroundcommunitiesmayexperiencethetool.

• Development of the tool:basedonwhatwaslearnedduringthereviewoftheliteratureandthestakeholderinterviews.DraftversionsofthetoolwerereviewedandrefinedbasedonadviceprovidedbytheProjectAdvisoryGroupmembersandpilotparticipants.

• Piloting of the tool:intwopublicdentalservicesinVictoria(1metropolitan,1regional)overafive-weekperiod,totestuseracceptabilityandcongruencewithworkflowinpublicdentalsettings.

ThisreportwaspreparedforDHSVattheconclusionofthesethreephases.Severalrecommendationsaremadeinthereportforfurtherworktosupporttheongoingdevelopmentofavalidandreliablestate-wideRefugeeandAsylumSeekerOralHealthRecallTool.


Literature review

etal.,2014).OnestudyfromtheUnitedStatesfoundthatSudaneserefugeeparticipantswerenotutilisingrecommendedpreventativebiannualcheck-upsandthatthemajorityofparticipantshadnotbeentoadentalfacilitymorethanoncepostarrival(Willis&Bothun,2011).

FactorsassociatedwithpoororalhealthThereisastronglinkbetweensocialdisadvantageandoralhealth,withmanysocialissuesthatareknowntohaveadetrimentalimpactonoralhealthstatusandaccesstodentalcareinthegeneralpopulation.Thesefactorsincludestress(Vasiliouetal.,2016),lowlevelsofincomeandeducation(Bernabéetal.,2011;Sabbahetal.,2007),homelessness(Parkeretal.,2011),unemployment(Al-Sudani,Vehkalahti,&Suominen,2016),andlivingwithmentalillness,disabilities,orcomplexmedicalconditions(COAGHealthCouncil,2015).Althoughnotallofthesefactorshavebeenspecificallylinkedtopoororalhealthinpeoplefromrefugeebackgroundsintheliterature,itisknownthatduetotheirdisplacementandresettlementexperiencesrefugeesmayarrivewithchronicandcomplexhealthconditions,experiencehighlevelsofstress,andaremorelikelytobeunemployed,homeless,orhavelowincomesandeducationallevelscomparedtothegeneralpopulation(StateGovernmentofVictoriaDepartmentofHealth,2014c;VictorianFoundationforSurvivorsofTortureInc.,2012).Since2012,whenhumanitarianprogramentrantswereprovidedaccesstoawaivertothemigrationhealthrequirements,theAustralianRefugeeandHumanitarianProgrammehassettledincreasingnumbersofpeoplelivingwithdisabilities(Duell-Piening,2016).

Thereareanumberofsocialriskfactorsspecifictopeoplefromrefugeebackgroundsthathavebeenfoundtoimpacttheiroralhealth.Theseincludearangeofpre-arrivalriskfactors,suchasperiodsofdeprivationinurbancentresorrefugeecampswithlackofaccesstocleanwater,nutritiousfood,oralhealthhygienetoolsandaccesstooralhealthcareservices(Lambetal.,2009;Nguyenetal.,2013;Willis&Bothun,2011).Furthermore,peoplefromrefugeebackgroundsmayhaveexperiencedtortureandtrauma,includingtraumatothemouthorteeth,andmayexperiencedentaleffectsofperiodsofprolongedstress,suchasbruxismandmucosallesions(Lambetal.2009).

The literature review aimed to identify research that exists on social and clinical health issues that lead to poor oral health outcomes and decreased access to oral health care for people from refugee backgrounds in resettlement contexts. Embase, Medline (Ovid), Pubmed, Informit, Proquest, CINHAL and Google Scholar were searched for relevant scholarly articles published between 2006 and 2016. The search terms used were ‘oral’ or ‘dental’ in combination with ‘asylum seeker’ or ‘refugee’. Reference lists were searched and articles or tools recommended by colleagues were also included in the results, and each abstract was screened for relevance.

Thereviewalsosearchedforexistingtoolsthathavebeendevelopedtoassessoralhealthriskspecificallyinrefugee-backgroundpopulations,orthatassesstheimpactofsocialrisksonoralhealthoutcomes.Noexistingtoolswereidentified.MonashHealthiscurrentlyconductingaprojecttoassessthesocialrisksofrefugeeandasylumseekerclientsattendingtheirdentalserviceinDandenong.Thisresearchisongoingandwillinvolvestatisticalanalysistodeterminecorrelationsbetweensocialrisksandoralhealthoutcomes(Marwahaetal.,2017).Thepublishedfindingsfromthisprojectwillsignificantlycontributetotheevidencebaseontheimpactofsocialrisksonoralhealthoutcomesforpeoplefromrefugeebackgrounds.

RefugeeoralhealthandaccesstodentalcareResearchindicatesthatpeoplefromrefugeebackgroundsexperienceahighburdenoforaldisease,includingdentalcaries,periodontaldiseases,malocclusion,orofacialtrauma,missingandfracturedteeth,andoralcancer(Davidsonetal.,2006;Ghiabi,Matthews,&Brillant,2014;Johnston,Smith,&Roydhouse,2012;Keboa,Hiles,&Macdonald,2016;Riggsetal.,2014).TheoralhealthstatusofpeoplefromrefugeebackgroundsisoftenpoorerthanothervulnerablegroupssuchasIndigenousAustralians(Davidsonetal.,2006;Ghiabietal.,2014;Keboaetal.,2016)andothergroupsofmigrants(Riggsetal.,2014).Aswellaspoororalhealthoutcomes,thereisevidencethatpeoplefromrefugeebackgroundsaccessdentalcare,particularlypreventativedentalcare,atverylowrates(Hobbs,2010;Riggs,Davis,etal.,2012;Riggsetal.,2016;Willis&Bothun,2011),andthattheirfirstdentalcontactistypicallyforemergencycare(Riggs


Therearealsoavarietyofsocialfactorsthatimpactpeoplefromrefugeebackgrounds’accesstodentalcareandtheirriskofpoororalhealthpost-resettlement.Theseinclude:competingsettlementdemands,fearandlackoftrustindentalpractitioners,languagebarriers,lowserviceliteracyandoralhealthliteracy,andchangesindiet.

CompetingsettlementdemandsDuringresettlementinanewcountry,peoplefromrefugeebackgroundsareoftenconfrontedwithavarietyofcompetingdemands,suchasfindingemploymentandaccommodation,thatmaybeprioritisedoverseekingdentalcare(Davidsonetal.,2007;Hobbs,2010;Lambetal.,2009).

FearandlackoftrustDistress,fearandlackoftrustcanactasbarrierstoaccessinghealthcare.Undergoingdentalcarecanbedistressingforpeoplefromrefugeebackgroundsandpeopleseekingasylum,particularlyiftheyhaveexperiencedtortureandtrauma,includingtraumatothemouth(VictorianFoundationforSurvivorsofTortureInc.,2012).Thisdistressandtraumacancontributetoincreasedfearinaccessingdentalcareanddifficultyinmaintainingregularoralhygienepractices(Lambetal.,2009).Furthermore,eventhosewhohavenotexperiencedtortureortraumatothemouthmayavoiddentalcareduetofearofextractions,fearofcontractingdiseaseatdentalservices,orlackoftrustindentalcareproviders(Hobbs,2010).

LanguagebarriersLanguagebarrierssignificantlyimpactaccesstooralhealthcareforpeoplefromrefugeebackgrounds(Hobbs,2010;Riggsetal.,2016;Willis&Bothun,2011).LimitedEnglishproficiencycreatesbarriersateverystageofaccessingdentalcare,including:knowingthataserviceexists,makingandattendinganappointment,describingthedentalissue,understandingtreatmentoptions,andbookingnewappointments(Hobbs,2010;Riggsetal.,2016).ResearchconductedwithrefugeesfromtheHornofAfricainMelbournesuggestedthatremindercallsforappointmentsmadeintheclient’slanguagewouldbeuseful(Hobbs,2010).

LoworalhealthserviceliteracyLackoffamiliarityandknowledgeofhowAustralia’soralhealthcaresystemworkscancreatesignificantbarrierstopeoplefromrefugeebackgroundsaccessingoralhealthcare(Hobbs,2010;Willis&Bothun,2011).Refugeesandasylumseekersmaybeunawareofserviceavailability,eligibilitycriteriaforpublicdentalcare,andpriorityaccessandfeeexemptionpolicies.PeoplefromrefugeebackgroundshavereportedthattheyfacefinancialbarrierstoaccessingdentalcareinAustralia(Hobbs,2010;Riggsetal.,2016;Willis&Bothun,2011).AsrefugeesandasylumseekersareentitledtofeeexemptionsforpublicdentalcareinVictoria,thesebarriersmaystemfrompeople’slackofawarenessofthesepolicies(Hobbs,2010;Riggsetal.,2016;Tyrrelletal.,2016;Willis&Bothun,2011).

Peoplefromrefugeebackgroundsmayhavedifficultiesnegotiatingserviceaccess,suchasknowinghowtomakeanappointmentatadentalserviceinabusycommunityhealthcontext(Hobbs,2010;Riggsetal.,2016),orthattheycanaskforanemergencyappointmentiftheyareexperiencingpain(Riggsetal.,2014).Limitedpriorexposuretoappointmentsystemscanmakeadheringtoappointmenttimesachallengeforsomenewlyarrivedcommunitymembers(Hobbs2010;Tyrrelletal.,2016).

LoworalhealthliteracyAlthoughloworalhealthliteracyisasignificantriskfactorforpoororalhealthinthewiderAustralianpopulation,loworalhealthliteracymaybeaparticularconcernforpeoplefromrefugeebackgrounds(Adamsetal.,2009;Hobbs,2010;Keboaetal.,2016).Formanypeoplefromrefugeebackgrounds,accessingpreventativecaremaybeanunfamiliarconcept(Hobbs2010;Keboaetal.2016;Tyrrelletal.2016),andthismaypreventtheiraccesstooralhealthcarewhennotinpain(Hobbs2010).Furthermore,manypeoplefromrefugeebackgroundscomefromcountriesinwhichdentalcareisveryinaccessibleorexclusivelyforthewealthy(Hobbs,2010).Asaresult,manypeoplebelievethatyoushouldonlyvisitthedentistifyouareinseverepainoryourteetharedecaying(Ghiabietal.,2014;Hobbs,2010;Keboaetal.,2016;Lambetal.,2009;Nicoletal.,2014;Riggsetal.,2016).Furthermore,theconceptthatdentalproblemsmayexistevenwhenoneisnotinpainmaynotbewellunderstood(Hobbs,2010).


PeoplemaybeunfamiliarwithWesternoralhygienepracticessuchastoothbrushingbeforetheyarrivetoaWesternresettlementcountry(Lambetal.,2009;Riggsetal.,2016).Intheirhomecountries,manypeoplepractisetraditionaloralhealthcarepracticesthatmaydifferfromWesternpractices(Adamsetal.,2013;Willis&Bothun,2011).Someexamplesoftraditionaloralhygienepracticesfromvariouscountriesincludeusinganindexfingertocleanseteethwithanashmixture,usingastickorbranchknownasamiswakasakindoftoothbrush,andusingreedsorgrassbetweenteethlikedentalfloss(Adamsetal.,2013;Geltmanetal.,2014;Nicoletal.,2014).Themiswakhasmixedeffectiveness;althoughitiseffectiveinremovalofplaque,itisnoteffectiveinpreventingdentalcaries(Adamsetal.,2013;Riggs,vanGemertetal.,2012).Peoplefromrefugeebackgroundsmayalsohavelimitedknowledgeaboutfluorideanditsroleinpreventingdentalcaries(Riggsetal.,2014).

Despitetheirvariedeffectiveness,traditionalpracticesusedtoimproveoralhygienemayhavestrongculturalandreligioussignificance.Forinstance,themiswakwasadvocatedforbytheprophetMohammedandmaybeusedbypeopleofMuslimfaithaspartofcleansingbeforeprayer(Adamsetal.,2013;Geltmanetal.,2014;Riggs,vanGemertetal.,2012).Duetoculturalandreligiousassociations,peoplemaybereluctanttogiveupthesetraditionalpracticesinfavourofWesternoralhygienemethods(Adamsetal.,2013;Willis&Bothun,2011).Astheseculturaltiesarestrong,theliteraturesuggeststhatitisimportantthattheybe‘understood,respectedandincorporatedwithinoralhealthcare,policiesandpractices’(Riggs,vanGemertetal.,2012).Peoplefromrefugeebackgroundsmayrequiredetailedoralhygieneeducationandtailored,culturallyappropriateoralhealthpromotionmessagestoaddressanyknowledgegaps,includingbetweentraditionalandWesternoralhealthpractices(Riggs,vanGemertetal.,2012;Willis&Bothun,2011).

DietarychangesNewarrivalsexperiencedietarychangeswhenmigratingtoAustralia,includingincreasedaccessibilityofpre-madeandpackagedfood,confectioneryandsugarydrinks,andsomepeoplemaybeunawareoftheimpactsofincreasedsugarconsumptiononoralhealth(Riggsetal.,2014;Willis&Buck,2007).AswellaslimitednutritionawarenessinanAustraliancontext,peoplefromrefugeebackgroundsmayfacefinancialbarrierstoeatingwellandpurchasinghealthyfoodinAustralia(Adamsetal.2013;Riggsetal.2014;Tyrrelletal.2016).Theoralhealthofpeoplefromrefugeebackgroundsmaydeteriorateovertimeastheyconsumemoresugaryfoodanddrinksintheircountryofresettlement(Geltmanetal.,2013).


AProjectAdvisoryGroupwasconvenedtoprovidehigh-levelstrategic,content,processandtechnicaladviceaboutthedevelopmentandpilotingofthetool.ProjectAdvisoryGroupmeetingswerechairedbyDentalHealthServicesVictoria(DHSV)andsecretariatsupportwasprovidedbyaprojectworkerfromtheVictorianRefugeeHealthNetwork.Membershipincludedrepresentativesfromthefollowingagencies:

• DentalHealthServicesVictoria(DHSV)• FoundationHouse• MonashHealth• cohealth• BarwonHealth• DianellaCommunityHealth• PlentyValleyCommunityHealth• NorthRichmondCommunityHealth• DepartmentofHealthandHumanServices• MurdochChildren’sResearchInstitute

TheProjectAdvisoryGroupmetattwokeypointsintheproject.MemberswerealsoinvitedtoparticipateinastakeholderinterviewwithaprojectworkerfromtheVictorianRefugeeHealthNetwork.

StakeholderinterviewsTenstakeholderinterviewswereconductedfromDecember2016toFebruary2017.Theaimsofthestakeholderconsultationswereto:

1. Understandtheservicecontext,includingstaffing,workflow,useofotherassessmenttools,useofrecallappointments,applicationofpriorityaccesspolicies,andreferralprocessesindifferentservicesettingsacrossthestate;

2. Scopeserviceproviders’viewsandrequirementsaboutthepurpose,formatandadministrationofthetool;and

3. Identifypilotsitesforthetool.

Publicdentalservicesareprovidedinclinicsoperatedbyhealthservicesandbycommunityhealthservicesacrossthestate.Interviewresponsesindicatethatstaffingconfigurationsandworkflowdifferindifferentservicesettings.Thiswasparticularlyevidentintheareaoforalhealthpromotionandeducation.SomeserviceshavedentalassistantswithaCertificateIVqualificationinoralhealthpromotionemployedinoralhealtheducatorroles,whileothersdonot.Asaresult,theapproachtoprovidingclientswithoralhealtheducationappearstovarywidely.

Inmanyservices,informationisprovidedchair-sidebytheclinicianduringorattheendoftheappointment.Inothers,clientswhoareidentifiedasbeingathigherriskofpoororalhealthoutcomesarereferredtoanoralhealtheducatorforaseparateappointmenttoaddressoralhealthliteracyandbehaviours.Anotherareaofdifferencewasthecollectionofsocialhealthinformation.Someservicescollectinformationonsocialhealthissuesatintake,ontheirreferralforms,oronpaper-basedformsinreception,whileotherservicessaidtheydonotroutinelyaskpatientsanyquestionsaboutsocialhealthrisks.

Inconsistentuseofriskassessmenttoolswasreported.Mostservicesindicatedthattheydonotuseexistingcariesriskassessmenttools,althoughoneservicehadadaptedorborrowedsomeofthequestionsforuseinitsownriskassessmentform.Reasonscitedfornotutilisingexistingtoolsarethattheyarenotmandated,thetoolsaretoolonganddetailed,thetoolsarenotsensitiveenough,andthatwithlimitedappointmenttimes,cliniciansaretoobusytousethem.

Thepriorityaccesspolicyforrefugeesandasylumseekersisapplieddifferentlyindifferentservicesettingsasthereisnoguidanceonhowlongarefugeeorasylumseekershouldbegrantedpriorityaccess.Someservicesprovidepriorityaccessforclientsfortheinitialcourseofcareonly,afterwhichtheclientgoesonthegeneralwaitlist.Othersprovidepriorityaccessfortheinitialappointment,andreferthoseclientswhoareassessedaslowriskaftertheyhavebeenseenbytheservicetothegeneralwaitlist.Atotherservices,clientsfromrefugeebackgroundshaveongoingorindefinitepriorityaccess.Mostservicesdonotuseadultrecallappointments.

Referralpracticesdifferacrossservices.Someservicessaytheydonotroutinelyaskpeopleiftheyneedareferraltootherservicesprovidedbycommunityhealthservices.Othersaskontheintakeformwhetheraclientwouldlikeinformationaboutanotherserviceatthecommunityhealthservice,andonlyreferiftheclienthastickedYes.Someservicesaskallpatientswhoindicateontheirmedicalhistoryformthattheyhaveachronicillnesswhethertheyhavearegulardoctor,andifnot,linktheminwithageneralpractitioneratthecommunityhealthservice.Someservicesreportedthattheymeetregularlywiththerefugeehealthteam,theintaketeamorthecounsellingteamattheirservicetodiscussreferralprocesses.

Project Advisory Group


Whendiscussingwhattheysawasthepurposeofthetool,orwhattheymightwantsuchatoolfor,serviceproviderssaidthattheyhopedthetoolmightassistwithdemandmanagement,andprovideclarityandconsistencyregardingpriorityaccesspoliciesandthequestionofhowlongsomeoneisconsideredarefugee.Manyprovidersspokeaboutpublicdentalservicesbeingafiniteresourceandtheneedtoensurefairnessofserviceprovision.Whileparticipantsfeltthatpriorityaccesspoliciesareimportanttoensurerefugeeandasylumseekerclientscanaccessservicesearlyintheirsettlement,someexpressedthebeliefthatoncetheclienthasbeenseenbytheservice,ongoingserviceprovisionandpriorityofaccessshouldbedeterminedbyneed.

Itwasfeltthatitwasimportanttobeabletoidentifythoseatriskofnotcomingbacktotheserviceduetosocialriskfactors,andsupportthoseclientstoaccesstheserviceforafollow-upappointment,untilthoseriskfactorscanbeaddressedorovercome.Itwasalsofeltthatthefocusshouldonlybeonsocialrisksthatimpactonoralhealthstatus,aperson’sabilitytomanagetheirownoralhealthcare,andabilitytoaccessongoingservices.Itwasalsofeltthatitisimportanttosupportdentalpractitionerstomakereferralsandidentifywhenaclientmayneedareferral.

Intermsofadministrationofthetool,itwasfeltthatthetoolshouldbeadministeredbyaclinicalstaffmember,suchasadentistordentalororalhealththerapist.Somefeltthatthetoolcouldbeadministeredbyanoralhealtheducator,iftheservicehasone.Wewereadvisedtousehigherandlowerriskclassificationsonly,ratherthanhigh,mediumandlow,toavoid‘fencesitting’andclassifyingeveryoneasmediumrisk.Itwasfeltthatreferralisthelogicalnextstepifsocialrisksareidentified,thatitisnotthedentalservices’jobtomanagepeople’ssocialrisks,andthatmanypatientsdonotwishtohavesocialrisksaddressedatthedentalservice.

Withregardtothetool’sformat,serviceprovidersunanimouslyagreedthatthetoolwouldneedtobeembeddedinTitaniumforittobeuseful–manyservicesarenowpaperless,withallclientdatamanagedthroughTitanium,anditwasadvisedthatthetoolwouldnotbeusedifitwasnotembeddedintoTitanium.Manypeoplespokeaboutdentalpractitionersbeingtimepoorandexperiencinghighadministrativeburdens.Therefore,itwasrecommendedthatthetoolbebrief–between3–10questionswastherecommendedlength–andachecklistformatwaspreferredoveropen-endedquestions,which

wereregardedastootimeconsuming.Wewereadvisedtoprovidepromptsandindicatorstoassistdentalstafftoaskandassesseachofthequestions,andtorecommendcoursesofactiondependingonthesituation,includingreferral,practicetipsandpromotionoforalhealtheducationresources,includinglinkstowheretheyareavailable.Participantsdiscussedtheimportanceofensuringthatthetoolisappropriatelyselective,sothattheoutcomeforeveryoneisnothigherrisk.Itwasadvisedthatcallingthetoolasocialriskassessment(asitwasoriginallyconceivedintheModelofCare)maymakedentalstafflesslikelytouseitiftheyseesocialhealthissuesasoutsidetheirscopeofpractice.

CommunityadviceCommunityadvicewassoughtduringthescopingphasefromcommunityliaisonworkersemployedintheFoundationHousecommunitycapacitybuildingteam.Communityperspectivesweresoughttoensurethatthequestionsandpracticetipsincludedinthetoolwouldbeacceptabletorefugee-backgroundcommunities.Thisadvicehighlightedthechallengesassociatedwithlowserviceliteracyfornewarrivals,andtheimportanceofexplainingthetreatmentprocessandgivingclient’soptions,inordertoestablishtrust,provideasenseofcontrolandreducediscomfortoranxiety.

FirstProjectAdvisoryGroupmeetingDuringthefirstProjectAdvisoryGroupmeeting,thegroupreceivedabriefingonthefindingsfromtheliteraturereviewandstakeholderinterviews,andreviewedandprovidedfeedbackonadraftversionofthetool.Participantsbrokeintosmallgroupstodiscussanddeveloprecommendationsabout:• thenameofthetool• itssuitabilityforuseintheirservicesetting• theindicatorsusedtoassessvariousquestions• referralpathwaysandprocesses• theweightingofthequestionsandthresholdfor

higherriskclassification.

Adviceprovidedbythegroupatthismeetingincluded:• That,asthetoolisdesignedtoassesswhichclients

requirearecallappointmentversusthosewhomaygoonthegeneralwaitlist,itshouldbecalledarecalltool,andnotasocialandclinicalriskassessmenttoolasitwasoriginallynamedintheModelofCare.


• Toinclude4visiblecavitiesand4activeareasofwhitespotlesionsasindicatorsofhighclinicalrisk.Thisisasopposedto1(aspertheDHSVCariesRiskAssessmentTool),asitwasfeltthatthiswouldbeoverlyinclusiveandidentifytoomanypeopleasoverallhigherrisk.

• Toincludeperiodontalriskquestionsamongtheindicatorsofhighclinicalrisk.

• Toincludesmokingamongtheindicatorsofhighclinicalrisk.

• Providingexamplesofchronichealthconditionsthatifnotwellmanagedmightleadtopoororalhealthoutcomes.

• Thatservicesshouldidentifyasinglereferralpointwithintheircommunityhealthservice,whichcanthenworkwiththeclienttoidentifythetypeofsupporttheyrequire,ratherthanrequiringoralhealthpractitionerstobeawareofthefullrangeofhealthandsocialservicesavailableinthecommunity.Insomecommunityhealthservicesthemostappropriatereferralpointmightbetherefugeehealthnurse;inotherstheserviceintaketeam,orthecounsellingorsocialworkteam.

• TosetthethresholdforanoverallhigherriskratingatrequiringaYesresponsetothreeormoreofthesevenriskfactors,includingapositiveresponseforeitherathighclinicalriskofpoororalhealthoutcomes,and/orhaveloworalhealthliteracyinordertobeconsideredatoverallhigherrisk.

SecondProjectAdvisoryGroupmeetingDuringthesecondProjectAdvisoryGroupmeeting,thegroupreceivedabriefingonthepilotprocessandfindings,hadtheopportunitytomakefinalrefinementstothetool,discussedrecommendedrecallperiodsforclientsidentifiedashigherrisk,andreviewedandprovidedfeedbackondraftrecommendationsfortheproject.

Therewasstrongsupportforasix-monthrecallperiodforclientsidentifiedashigherrisk.Itwasfeltthatimplementingasix-monthrecallperiodfornewarrivalsidentifiedashigherriskwouldprovidepeoplewithasufficientlevelofcareandhelptoembedoralhealthpromotionmessagesandbehavioursearly,whereaswaiting12monthsmayriskthecycleofdiseasestartingagain.Itwasidentifiedthatrecallinghigherriskpatientstoreassessidentifiedriskfactorsaftersix

monthspresentstheopportunitytopractiseMinimumInterventionDentistry,whichfocusesonprevention,earlyidentificationandinterceptionofdisease(Walsh&Brostek,2013).Thetoolwouldbereadministeredatthesix-monthrecallappointmenttoassesswhethersignificantriskfactorsremain.Clientswhoremainathigherriskwouldremainonasix-monthrecall,whileclientsforwhomriskfactorshadbeenreducedcouldbereferredtothegeneralwaitlist.Thisisconsistentwiththeliteraturethatindicatesthatrecallintervalsshould‘becustomisedtofitapatient’sindividualneeds,basedonariskassessment’(Gussyetal.,2013).

Thisapproachwouldcreateanincentiveforservicestoprioritiseoralhealtheducationforhigherriskclients.Whiletherewasconsensussupportforasix-monthrecallperiod,aconcernwasraisedabouttheabilityofservicestomeetthisdemand.

DHSVwasadvisedtoconsidertrainingrequirementstosupportdentalservicestoadoptthetoolandembeditineverydaypractice.Itwasadvisedthattrainingshouldincludeinformationabouttherefugeeexperienceandworkingwithclientsfromrefugeebackgrounds,whichcouldbedeliveredinpartnershipwithFoundationHouse,aswellasinformationabouttheModelofCareandthetool.


Refugee and Asylum Seeker Oral Health Recall Tool

The development of the tool was informed by what was learned during the review of the literature and the advice of the Project Advisory Group, community liaison workers and pilot participants. See the Appendix: Refugee and Asylum Seeker Oral Health Recall Tool.

Based on the advice received, the tool features only seven questions, with associated indicators to assist the oral health practitioner administering the tool to assess the client across each of the seven questions. The tool also includes practice tips and referral advice to support the practitioner to respond where high risks are identified. Respondents are asked to tick the box to indicate a Yes response. A client requires a Yes response to three or more of the seven risk factors to be assessed as overall higher risk. This must include a Yes to Question 1 (high clinical risk) and/or Question 2 (low oral health literacy).


Piloting of the tool

Amid-pilotreflectiveteleconferencewasheldwithstafffrombothpilotsites(Study).Duringthisteleconference,staffparticipatinginthepilotprovidedfeedbackabouttheirexperienceadministeringthetool,andtheirclient’sexperienceofbeingaskedthequestions.Someminoramendmentsweremadetothetoolbasedonthefeedbackprovided.

Followingtheteleconference,thetoolwaspilotedineachoftheservicesforafurthertwo-weekperiod(Act).Attheconclusionofthepilot,stafffrombothservicesparticipatedinapost-pilotteleconferencedebrief.

Staffadministeringthetoolwereaskedtoprovideresponsestosomeprocessevaluationquestionsthatwereaddedtothetoolforthepurposeofthepilotonly.Thequestionsincludedwhethertheclientwascomfortablewiththequestions,whethertheindicatorswerehelpfulinassistingthemtoassesstheclientforeachquestion,whetherthecliniciancameupwithanyotherwaysofaskingorassessingthequestion,whethertheyusedthepracticetips,andwhethertheyfelttheoverallratingwasappropriatefortheclientornot.Afterthemid-pilotteleconference,somedemographicquestionswereaddedtothebackofthetool,includingclient’scountryofbirth,preferredlanguage,ageandlengthoftimeinAustralia.

PurposeThepurposeofthepilotwastotestuseracceptabilityofthetoolanditscongruencewithworkflowinpublicdentalsettings.

PilotsitesDuringthestakeholderinterviews,publicdentalagencieswereinvitedtoself-nominatetopilotthetoolintheirservice.Twoagenciesvolunteeredtoparticipateinthepilot.Cohealth,acommunityhealthorganisationthatprovidesservicesacrossMelbourne’sCBD,northernandwesternsuburbsvolunteeredtopilotthetoolatitsKensingtondentalclinic.BarwonHealth,acomprehensiveregionalhealthserviceoperatinginthegreaterGeelongareaandthroughoutsouthwestVictoria,volunteeredtopilotthetoolatitsCoriodentalclinic.

PilotoverviewTheimplementationofthepilotwasinformedbythePlan,Do,Study,Act(PDSA)approach,amethodforplanningandtestingchangesthroughsmallcycles,settingasidetimetostudytheresults,andrefiningtheimplementationbasedonwhatwaslearned(InstituteforHealthcareImprovement,2017).ThePDSAapproachwasrecommendedbyoneoftheProjectAdvisoryGroupmembersasausefulframeworkforintroducingnewinitiativesinhealthservicesettings(Yellandetal.,2015).

Trainingsessionswereconductedateachofthepilotsites(Plan).Thetrainingprovidedanopportunityforstaffparticipatinginthepilottolearnaboutthebackgroundandpurposeofthetool,familiarisethemselveswiththetool,includingbreakingintopairsorsmallgroupstopractiseadministeringthetool,criticallyreflectonhowthetoolmaybeimproved,anddevelopaplanforcollectingthepilotdata.Somerevisionsweremadetothetoolbasedontheadviceprovidedbypilotparticipantsduringthetraining.

Followingthetraining,thetoolwaspilotedforaninitialthree-weekperiod(Do).Itwasagreedthatthetoolwouldbeadministeredbydentists,dentalororalhealththerapists,anddentalprosthetistsatallgeneralordentureappointmentswithanadultrefugeeclientduringthepilotingperiod.


Overthefive-weekpilotperiod,thetoolwasadministeredwith70adultclientsfromrefugeebackgrounds(37atBarwonHealthand33atcohealth).Thebreakdownoftheprofessionalbackgroundofthecliniciansadministeringthetoolwas:• Dentist:n=40• Dental/oralhealththerapist:n=24• Dentalprosthetist:n=5• Other(notspecified):n=1

Table1showsthenumberandpercentageofclientsthatwereassessedashighriskforeachofthesevenquestionsinthetoolandfortheoverallhigherriskrating.Ofthe70clientswithwhomthetoolwasadministered,37%(n=26)wereidentifiedasoverallhigherrisk–thatistheclientwasassessedasbeingathighclinicalriskofpoororalhealthoutcomesand/orashavingloworalhealthliteracy,plusoneortwootherriskfactors.

Table 1: High risk ratings

Risk factor Number %

High clinical risk 52 74%

Low oral health literacy 40 57%

Low service literacy 27 39%

Chronic health 2 3%

Disability 2 3%

Homeless 6 9%

Highly distressed 1 1%

Overall high risk 26 37%

Thresholdforoverallhigherriskrating

Forthepurposeofthepilot,thethresholdforanoverallhigherriskratingwassetatthree(inclusiveofhighclinicalriskand/orloworalhealthliteracy).Thismeantthatjustoverathird(37%)oftherefugee-backgroundclientsparticipatinginthepilotwereidentifiedashigherrisk.AnalysisofthedataindicatesthatifthethresholdhadbeensetattwoYesanswers,overhalf(56%)ofclientswithwhomthetoolwasadministeredwouldhavebeenclassifiedashigherrisk,andifthethresholdhadbeensetatfourYesanswers,thenonly6%ofclientswouldhavebeenidentifiedashigherrisk.Indiscussingthesefindings,theProjectAdvisoryGroupmembersagreedthatthethresholdhadbeensetattherightlevel,andrecommendedthethresholdremainatthreeYesanswersthroughoutfurthertestingandtriallingofthetool.

Itisinterestingtonotethat24of27peoplewhohadlowserviceliteracyalsohadoneofthetwoessentialhighriskcriteria(poororalhealthliteracyorhighclinicalrisk).

Table 2: Number of risk factors identified in refugee-background clients during pilot period

Risk factors Number of people %

0 9 13%

1+ 61 87%

2+ 39 56%

3+ 26 37%

4+ 4 6%

Findings and discussion


Useracceptabilityandcongruencewithworkflow

“I found the tool really easy to use, it wasn’t too long, it was easy to understand, I wouldn’t change anything.” (clinician participating in the pilot)

ThefeedbackprovidedduringthePDSAcycleindicatesthatthecliniciansparticipatinginthepilotfoundtheRefugeeandAsylumSeekerOralHealthRecallToolacceptableanduseful.Cliniciansappreciatedthebrevityofthetool,giventhetimepressurestheyareunder.Thisensuredthetoolwasfeasibletoimplementinabusypublicdentalsetting.

“I like how short it is – just seven questions.” (clinician participating in the pilot)

Cliniciansreportedthatthetoolfitswellintotheirworkflowandthatthequestionswereeasilyandnaturallyincorporatedintotheclinicalconsult.

“I found the tool very easy to use in a clinical situation. The questions were easy to ask, it just flowed … it was easily incorporated into general client conversation.” (clinician participating in the pilot)

Cliniciansadministeringthetoolwereaskedwhethertheyfelttheoverallratingwasappropriate,basedontheirclinicalimpressionsoftheclient.Allparticipantsfeltthattheresultswereappropriateandthetoolwasacceptableindeterminingoverallhigherriskratings.Allagreedthattheindicatorsandquestionswerehelpfulinassistingthemtoassesstheclientforeachofthequestions.

“The information in the boxes was very helpful.” (clinician participating in the pilot)

Cliniciansalsoadvisedthatthetoolwasusefulforidentifyingopportunitiesfororalhealtheducationandprovidedausefulframeworkfortailoringoralhealthpromotionmessagestotheneedsoftheclient.

“A few of the indicators uncovered some interesting client perspectives, for example the questions about fluoridation. It was a good conversation starter … The questions were helpful with sparking conversations from an oral health education perspective.” (clinician participating in the pilot)

TheclientexperienceClinicianswereaskedtocommentontheclientexperienceofthetool.Everyoneindicatedthatclientstheyadministeredthetoolwithwerecomfortablewiththequestions.Furthermore,cliniciansreportedthatclientsappreciatedbeingaskedaboutabroaderrangeofissuesaffectingtheirhealthandwellbeing.

“The clients were happy with it, because it starts a conversation about things outside of dental, I think it makes them feel important.” (clinician participating in the pilot)

Alownumber(n=12)oftoolswereadministeredusingtheupdatedversionwheredemographicclientinformationwascollected,someaningfulconclusionscannotbemadefromthedatacollected.However,withinthesmallsampleitwasnotedthatalloftheclientswhohadbeeninAustraliaforlessthansixmonthswereassessedashavingloworalhealthliteracyandlowserviceliteracy.Thisindicatesthatcollectionofdemographicdatamayassistwithbetterunderstandingofdifferencesacrosscohorts.


Recommendations

RECOMMENDATION 5

DHSVembedtheRefugeeandAsylumSeekerOralHealthRecallToolinTitaniumtofacilitateitsuptakeandusability.

RECOMMENDATION 6

DentalservicesimplementingtheRefugeeandAsylumSeekerOralHealthRecallTooldevelopandutilisereferralpathwayswithintheircommunityhealthservicetosupportclientsforwhomhigherrisksareidentified.

RECOMMENDATION 7

DHSVutilisethefindingsfromabroadertrialoftheRefugeeandAsylumSeekerOralHealthRecallTooltoinformfurtherdevelopmentoftheModelofCareforRefugeeandAsylumSeekerOralHealth.

BasedontheadviceprovidedbytheProjectAdvisoryGroupandthefindingsfromthepilot,theVictorianRefugeeHealthNetworkrecommends:

RECOMMENDATION 1

DHSVfacilitateatrialoftheRefugeeandAsylumSeekerOralHealthRecallToolacrossalargernumberofservicesacrossthestatetoassessthevalidityandinter-raterreliabilityofthetool.Thisshouldincludedemographicdatatounderstanddifferencesacrosscohorts.

RECOMMENDATION 2

Dentalservicesparticipatinginthetrialconsiderimplementingasix-monthrecallperiodforclientsidentifiedashigherrisk,subjecttoaDHSVreviewoftheevidenceforasix-monthrecall.

RECOMMENDATION 3

DHSVconsidertheevidencefromtheMonashHealthSocialRiskAssessmentresearchprojectinthedevelopmentofafinalversionoftheRefugeeandAsylumSeekerOralHealthRecallTool.

RECOMMENDATION 4

DHSVsupportagenciestoadoptandimplementtheRefugeeandAsylumSeekerOralHealthRecallToolbyfacilitatingprofessionaldevelopmentaboutrefugeeandasylumseekerexperiences(inpartnershipwithFoundationHouse),theModelofCare,andthetool.


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Appendix:RefugeeandAsylumSeekerOralHealthRecallTool

Talking about health and experiences of using health services with people from refugee backgrounds

refugee and asylum seeker oral health recall tool...

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