Integrated health and social care for people experiencing homelessness

Overview

Despite being largely preventable, oral diseases remain a global public health challenge. The most marginalised and socially excluded groups in society such as people experiencing homelessness, drug and alcohol dependence, prisoners, people with disabilities and refugees experience extreme oral health inequalities with very high levels of oral diseases, compounded by limited access to services. The work presented here represents an example of a health inclusion model targeting people experiencing severe and multiple disadvantage (SMD), such as homelessness, problematic substance use and repeat offending, which has integrated dental education, service development and research and evaluation of outcomes using a community participatory approach.

A systematic review of the barriers and facilitators to accessing dental care for people experiencing homelessness in the UK carried out in collaboration with Public Health England found links to both the lived experience of homelessness and the nature of the healthcare system. This review, the first to conceptualise factors impacting on people experiencing homelessness, suggested changes to practice, education and policy to address the complex issues that socially excluded groups face in improving their oral health. At service level, the review identified a need for dental services to be reconfigured and delivered in a way that recognises patients' complex and diverse needs. It also highlighted the need to empower people experiencing homelessness to adopt good oral hygiene habits and to promote engagement of dental students with marginalised populations through outreach.

Despite their greater needs, people experiencing homelessness are not able to access universal services in an equitable way. The team has led research on inclusion in oral health with a number of vulnerable groups and has developed models of care using a community engagement approach. Their research has been pivotal in contributing to the evidence base, influencing practice, commissioning strategies and prioritisation in the Southwest and influencing national evidence-based policy decisions. This case study focuses on people experiencing SMD.