The first key outcome of the project was the development of new resources that support the Victorian public oral health sector. A Model of Care, two Factsheets on identifying and working with clients of refugee and asylum seeker background, and a central resource repository were developed by the Project Worker with assistance from the Project Advisory Group. The Model of Care and the complementary Factsheets were designed to support services to implement Priority Access and Fee Exemption policies. Further, the proposed Model of Care places a focus on oral health education which assists to minimise late-stage and costly interventions, consistent with developments in relation to Minimal Intervention Dentistry (MID). The Model of Care encourages dental staff to observe and assess clients for clinical and social risks that may impact on the client’s oral health care and/or client ability to renegotiate complex appointment systems for follow up care; and, based on this assessment, to set up recall for clients who show high oral health risk (including any identified clinical and social risks). The Model of Care also aims to provide services with guidance to assist in ascertaining when those of refugee background can be assessed as no longer requiring Priority Access. The Model of Care has been positively received by practitioners and services, however needs to be incorporated into policy and guidelines in order to support its implementation.
In addition to the Model of Care and Factsheets, a collection of refugee oral health literature and resources have been collated into a repository on the Victorian Refugee Health Network website www.refugeehealthnetwork.org.au. The project identified a need for additional pictorial, translated and interactive web-based oral health information to be developed, especially on the topic of health education for people of refugee backgrounds. Oral hygiene maintenance, how to navigate the oral health care system, and what to expect before and after a dental treatment are suggested themes.
Another key output was the development, trialling and evaluation of the Refuge Oral Health Targeted Education Program (TEP) – a professional development curriculum for oral health service staff. Evaluation of the TEP showed that staff who participated in the program demonstrated an increase in (a) knowledge, (b) confidence and (c) understanding of practice in working with clients of refugee and asylum seeker backgrounds.
There is a high demand for oral health training and evidence from this project shows that the TEP is not only informative, but also effective in changing perception and practice in oral health service delivery. The TEP should be implemented across Victoria in services responding to high numbers of refugee and asylum seeker clients. While there is a need to make the TEP widely available, this also has resource implications and it is suggested that these could be partially addressed by making some of the learning modules available online.
The project also identified the need for regional or statewide forum(s) to promote the findings of the project and promote good practice across services. It will be important to continue to develop opportunities for dental professionals, researchers, government and refugee related services to come together to share clinical expertise, emerging issues, clinical presentations, case studies and service developments, specific to working with clients or refugee and asylum seeker background.
A lack of formalised pathways between dental, intake, Refugee Health Nurses and settlement services was highlighted during the TEP as an area for further development, and for consideration in other services.
Finally, this project highlighted significant gaps in Australian research in relation to the following areas: the oral health status of new and recently arrived refugee background populations (noting changing demographics now and in the future); evidence regarding approaches to providing better access, appropriate clinical care and addressing oral health literacy for refugee background population (including oral health promotion and education); and in new and emerging approaches such as Minimal Intervention Dentistry (MID). The recommendations below provide next steps in implementation in the areas of policy, referral pathways, professional and organisation development, resources and research.
Authored by: Thuy Nguyen, Sue Casey, May Maloney & Stephanie Rich on behalf of the Project Advisory Group