Kelli Adreon Aimee Martin Needs Assessment

A. General Data 1. Description of Site Some Other Place was founded in 1968 by a group of churches, and is under the leadership of a local pastor. The program was launched as an outreach facility for those individuals suffering from economic hardships that could not get help from other available agencies. There are 13 religious denominations representing Some Other Place; which is supported by local donations to run the actual facilities, paying for items such as utility bills, office supplies, garbage pickup, etc. State and Federal grants are used directly for services to clients. These funds do not pay for operating costs but are solely used for public services. Grants are available from various resources such as Housing and Urban Development (for housing expenses), community block grants, food, and emergency grants from Catholic Charities. Within Some Other Place exists Henrys Place, which gives the homeless access to laundry facilities, showers, counseling, and a breakfast meal during the hours of 8:30-11:30 AM, Monday through Thursday. It is not open on the weekends. Other services can be accessed on site, if needed. These include Social Security Administration, Veterans Administration services, Health Department services, HIV/AIDs services, etc. Henrys Place is a brief respite from the streets, as quoted by the director. 2. Description of Target Group The clients being served by Henrys Place must be homeless. Most are chronically homeless and necessary proof is given through general appearance and hygiene, clothing, possessions, and other personal factors. Daily, there are about 70-75 individuals who take advantage of the services at Henrys Place. The general age range of clients is 30-50 years of age, although clients range from ages 18-70. Most are African-American, however, the Hispanic population is growing. The majority of clients tend to be male because females are more likely to receive help elsewhere and are more inclined to take lower wage or menial jobs. 3. Description of Staff Population Some Other Place has 8 full-time employees, 6 part-time employees, and as many as 200-300 volunteers per week. The director of Some Other Place oversees all activities and facilities under the non-profit business. The director holds a Masters Degree, and is a member of various local philanthropist groups. Two of the full-time employees run the facilities of Henrys Place. The director of Henrys Place does not have a degree but

performs needs assessments of the individuals coming in to determine what assistance is needed, (i.e. bus tickets, financial services, medicines, and other funds). The other fulltime employee is a Licensed Practical Counselor. Responsibilities of this position are: mental health counseling and services, substance abuse counseling, and other social disorders. The volunteers, most of which are female, help check in the homeless, cook, clean, schedule showers, and socially interact with clients to give them a sense of selfworth. 4. Description of Services Provided In the future, the director states, it would great if Some Other Place were to become a safe haven since Beaumont does not have one. As stated above, services provided are: laundry facilities, showers, breakfast, companionship, help with financial needs, help applying for assistance through various organizations, and provide other commodities. Clients receive donated items for personal hygiene and basic needs. These items range from toiletries, blankets, clothing, insect repellent, bus tickets, Transportation Worker Identification Credential cards, IDs, books, and medications. Short-term services for some mental health clients include: housing deposits, rent, and utility bills. Throughout the year, special events are held to gather supplies for the less fortunate. Some Other Place also pays for or offers transportation to doctors/dental visits and emergency room visits, if medically necessary. There is a soup kitchen on site at Some Other Place but it only serves lunch meals and does not provide any other services. 5. Other Pertinent Information Water fluoridation in the area of Some Other Place is .8 mg/L, although it is unknown how much water is being consumed by the homeless to prevent caries. The water in Beaumont has been fluoridated since July 1, 1971 and measurements include the natural and added amounts of fluoride. B. Information Related to Dental Health 1. Previous Dental Programs At one time, a dentist came on Saturdays to provide services but has since retired and the facility no longer has anyone to provide oral health services or education. Some Other Place does work with the Diocese of Beaumont to schedule screenings and treatments. In the past, homeless clients have visited public service locations like Texas Missions of Mercy and the Lamar Institute of Technology clinic. TMOM provided care such as, extractions, root canal therapies, denture fabrication, and limited prophylaxis. LIT provides oral cancer screenings, full prophylaxis treatment, fluoride treatment, aesthetic polishing, radiographs, and dental education.

2. Dental Attitudes of Homeless Clients have a tendency to avoid seeking treatments due to financial costs and the thought that if it doesnt hurt, there is no pressing need to receive treatment. It is believed if the individuals avoid the problem, they will not be able to speak it into existence. Since most of the patrons cannot afford treatment, they will just continue to ignore pain or other concerns until it escalates to a detrimental degree. 3. Dental Health Education At this time, oral education is limited to what the staff is aware of but no outside sources exist, to date. 4. Oral Aids Available Toothbrushes and dentrifices are provided but floss is only provided if requested or available. Mouthrinses are not provided unless they are alcohol-free, due to concerns of alcohol abuse. C. Dental Health Status 1. Dental Caries Numerous factors contribute to poor oral care and conditions in the oral cavities of homeless individuals. Often, these factors cause decay. In the city of Boston, untreated dental caries were found in over 90% of homeless adults (Bolden & Kaste, 1995). Two-thirds of these people are uninsured, and Medicaid only covers extractions for the disabled; it does not cover preventive or restorative care (Bureau of Primary Health Care, 2001) (Burt & et al, 1999). Therefore, most of the individuals who are homeless are unable to seek needed care. Dental caries can cause a number of problems such as trouble eating, abscesses and interference with social interaction due to embarrassment or pain. 2. Periodontal Disease According to the CDC, one out of every two adults in the United States has periodontal disease to some degree. Periodontal disease is higher in men than women with prevalence being 56.4% to 38.4%. The study also shows periodontal disease is higher in MexicanAmericans at 66.7% compared to other races. Current smokers are listed as having a prevalence of 64.2%, those falling into the federal poverty level have a rate of 65.4%, and those with less than a high school education have a prevalence of 66.9% (Eke, Dye, Wei, Thornton-Evans, & Genco, 2012). This is relevant to our target population since most of the individuals receiving services are men, black or Mexican, and fall into the federal poverty level. Homeless persons are 12 times more likely than individuals with stable housing to have dental problems. Persons living in unstable housing are 6 times more likely to have

dental problems (Ferenchick, 1992). Homeless adults have more intensive dental problems, such as periodontal disease and edentulism (a complete lack of teeth); however, their use of dental services is less than the general populations (GAO, 2000). With this being said, tooth loss is common among adults living on the streets or in and out of shelters, but cannot be addressed due to lack of services available to the low or no-income individuals. 3. Oral Hygiene The homeless are unlikely to have access to oral hygiene essentials such as toothbrushes, toothpaste, and interdental aids. Oral hygiene may also not be of high priority to them due to more pressing needs such as adequate living situations and medical issues. Most of these individuals will not seek medical attention unless they present with pain, so preventive measures such as prophylaxis will not be sought out. Therefore, poor oral hygiene is common among the homeless, and minimal attention is paid to the oral cavity it is not viewed as an urgent need to them. Lack of nutrition is also a concern that contributes to oral diseases and conditions. Without proper nutrients, infections cannot heal and an unhealthy environment is created in the mouth. Many of the homeless population have no means of obtaining knowledge about the oral cavity, so they may not understand how to care for their teeth, so, as a result, the situation is neglected.

4. Oral Cancer Smoking is a major cause of oral cancer which includes use of cigarettes, cigars, chewing tobacco, and snuff. Oral cancer caused from these products can also be exacerbated with the combined use of alcohol. This becomes a major problem when nearly half of povertystricken individuals use tobacco products (Moore & Durden, 2010). If oral cancer is discovered, persons who are homeless are very unlikely to seek medical attention due to lack of finances or self-worth. For many of them, tobacco use is something they are unwilling to give up or they are unaware of the repercussions.
Table 2. Tobacco and Alcohol Consumption and knowledge Tobacco use, n (%) Cigarette smoking Cigar smoking Tobacco chewing Snuff use Aware that tobacco use can cause lung cancer Aware that tobacco use can cause head/neck cancer Alcohol use Current drinking, n (%) (n = 255) 136 (53.2%) 28 (10.9%) 9 (3.5%) 2 (0.8%) 182 (71.2%) 51 (19.9%) (n = 251) 68 (26.6%)

(Table 2) displays tobacco and alcohol consumption knowledge among a homeless population. (Specialty care requires creativity and collaboration, 1998)

5. Utilization of Dental Services Oral health care is available to homeless individuals in clinics and organizations across the United States at low or no cost, but this does not mean they will take advantage of these services. City supported events which provide screenings, patient care, and complex treatment are offered. Organized dental campaigns such as Project Homeless Connect have been launched and reach hundreds of cities nationwide (Project homeless connect, n.d.). Dental schools and clinics also provide care at minimum or no costs to persons that cannot afford dental care elsewhere. Transportation, funds, motivation, and more important basic life needs often present obstacles to the homeless as far as taking care of oral health problems.

6. Additional Information Substance abuse and mental health problems, often related to one another, are common among the homeless population and can be a cause and contributing factor of homelessness. These people often find themselves on the streets as a result of their disease, and then are unable to correct the situation, therefore, it becomes their way of life. The diseases themselves can contribute to dental problems, and poverty can then exacerbate the issue (Bringing America Home, 2009).

Goals and Objectives

Goal To utilize personal, LIT dental clinic, and other pertinent resources to develop an oral health education program that would potentially have a positive impact on the health of homeless individuals. Objective #1 To improve the oral health of homeless individuals by developing, coordinating, and implementing a community health program to educate our clients on the prevention and control of oral diseases and conditions. Objective #2 Provide a health program for residents and staff of Some Other Place Henrys Place that increases oral health knowledge and skills in maintaining optimal oral health. Objective #3 Increase the utilization of dental services and daily hygiene plaque control procedures (brushing and flossing).

Rationale for Program The purpose of this program is to educate and better the health of homeless individuals seeking help at Some Other Place Henrys Place in Beaumont, Texas. With only two full-time employees at the

location, and no dental outreach programs ever sought out, we would like to offer oral hygiene education and some services to improve the lives of these individuals. Although, it is impossible to lend a hand to everyone at the center, making a difference in a few could increase the communitys awareness and dental knowledge. Program Design A. Activities 1. Teach proper oral hygiene care on typodont a. Brushing b. Flossing c. Access psychomotor function 2. Record plaque indices a. Obtain before brushing and flossing b. Obtain after brushing and flossing c. Educate why this is important 3. Supply visual aids on oral health which display effects of tobacco, drugs, and alcohol use and their contribution to oral cancers and diseases. a. Aids that show effect of alcohol, tobacco, and drug use b. Provide pamphlets on how to quit and the benefits 4. Provide information on periodontal disease processes. a. Visuals of healthy tissue b. Visuals of diseased tissue 5. Provide nutritional counseling and examples of cheap, healthy foods and drinks a. Caries process visual aids b. Explanation of fermentable carbohydrates and bacteria c. Effects of acid enamel erosion 6. Gingival assessments a. Disease presence or absence b. Gingivitis or periodontitis c. Mild, moderate, or advanced d. Flip-charts that show bone level of health and disease 7. Oral cancer screenings a. Check tongue b. Check vestibules and mucosal tissues c. oropharynx 8. Benefits of fluoride explanation a. In toothpaste b. In tap water c. Mouthrinses (Act) B. Constraints and Alternative Strategies 1. Alter brushing techniques and provide modified techniques if necessary. 2. Explain ways to improve plaque score and keep it to a minimum on a daily basis. 3. If oral cancer is suspected, refer clients to a facility that can offer help. 4. Offer cessation options such as quit hotlines and counseling services.

C. Resources 1. Supplies: a. Toothbrushes, toothpaste, floss, non-alcoholic mouth rinses Colgate and Listerine supply companies b. Brochures, lists of places where they can seek emergency and low to no cost routine care. ordered and obtained via internet sources c. Disposable gloves, masks, cotton swabs, tongue depressors, gauze, paper napkins, eyewear, disclosing solution, flashlight, handheld mirror, cups, disposable mirrors provided by LIT dental hygiene clinic and students d. Visual aids 1. Posters to aid in learning process 2. Advertising flyers to promote program 3. Pamphlets to educate clients 4. Student typodonts e. Personnel 1. LIT students as educators and program planners 2. Any assistants or volunteers from Henrys Place willing to donate their time D. Budget 100 Toothbrushes 100 Floss 100 Toothpastes 100 Alcohol-Free Mouthrinses 100 Cotton Swabs 1 bottle disclosing solution 100 tongue depressors 1 box of face masks 2 boxes of gloves 100 paper napkins 2 flashlights 100 brochure/pamphlet copies 200 sterilized gauze squares 100 disposable cups 100 autoclaveable plastic mouth mirrors 2 sets of eyewear 2 typodonts 1 poster 10 flyers Estimated total Provided by Colgate Provided by Colgate Provided by Colgate Provided by Listerine $10.00 $5.00 $10.00 $10.00 $30.00 $5.00 $20.00 $20.00 $15.00 $15.00 Provided by LIT DH clinic Provided by LIT students Provided by LIT students $5.00 $5.00 $150.00

E. Timetable The oral hygiene program to be implemented at Some Other Place Henrys Place will last a total of four weeks. The following is expected dates and times of sessions to be held. Session 1 45 minutes to 1 hour Session 2 45 minutes to 1 hour Session 3 45 minutes to 1 hour Session 4- 45 minutes to 1 hour Evaluation A. Formative: Discuss with volunteers the outcome of each session and what was learned with clients Ask questions at the end of each session to review topics learned Watch how skills learned are demonstrated B. Summative: Participants will be given a pretest and posttest at each session to determine the level of dental knowledge attained before and during the sessions Program evaluation forms will be given and collected from volunteers, then subsequently reviewed by LIT students Record the approximate age, ethnicity, gender of clients who participated in oral health program Meet with the program director after oral health program to determine if clients oral health has improved. Tuesday, March 25 @ 9-10 AM Tuesday, April 1 @ 9-10 AM Tuesday, April 8 @ 9-10 AM Tuesday, April 15 @ 9-10 AM

Bibliography
Bolden, A. J., & Kaste, L. M. (1995). Dental caries in homeless adults in Boston. J Public Health Dent, 55(1), 34-36. Bureau of Primary Health Care. (2001). Homelessness and oral health. bphc, 9(1), 1-8. Retrieved from www.bphc.hrsa.gov/hchirc/newsletter Burt, M. R., & et al. (1999). United States Department of Housing and Urban Development. Retrieved from http://www.huduser.org/publications/homeless/homeless_tech.html Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O., & Genco, R. J. (2012, August 30). Prevalence of Periodontitis in Adults in the United States:2009 and 2010. Journal of Dental Research. doi:10.1177/0022034512457373 Ferenchick, G. S. (1992). The medical problems of homeless clinic patients: A comparative study. Journal of General Internal Medicine, 7(3), 294-297. GAO. (2000, April). Retrieved from U.S. Government Accountability Office: www.gao.gov/new.items/he00072.pdf Moore, C. E., & Durden, F. (2010). Head and neck cancer screening in homeless communities heal: (health, education, assessment, and leadership). Journal of the National Medical Association, 102(9), 813. (1998). Opening Doors: Information from Health Care for the Homeless Program. Retrieved from Health Resources and Services Administration, Bureau of Primary Health Care. Project homeless connect. (n.d.). Retrieved from dental.pacific.edu: http://dental.pacific.edu/Community_Involvement/Project_Homeless_Connect.html (2009). Substance abuse and homelessness. Washington, D.C.: National Coalition for the Homeless. Retrieved from Bringing America Home: http://www.nationalhomeless.org/factsheets/addiction.pdf

Appendix

Lesson Plan 1 3/25/14

1. Introductory Statement a. Homeless individuals attending breakfast at Some Other Place Henrys Place, all ages b. Length of time 9-10 AM 2. Objectives a. Describe plaque in detail (cognitive domain). b. Show interest in taking charge of oral health needs (affective domain). c. Apply knowledge by demonstrating brushing skills on oneself (psychomotor domain). 3. Content Outline a. Plaque Describe how plaque forms from bacteria and that it is a sticky substance that allows bacteria to adhere to the tooth surfaces. Explain that plaque begins to build up again almost immediately after brushing. b. Brushing how to perform proper brushing techniques, mainly in the sulcular motion at a 45 degree angle and its importance in maintaining good oral health. Explain brushing removes plaque inhibiting bacteria that can break down the tooth structure after bacteria metabolize fermentable carbohydrates. 4. Activities which the student will engage a. Initiatory activities 1. Introduce ourselves 2. Present topic of plaque 3. Present visual aids showing effects of plaque accumulation 4. Pre-test b. Developmental activities 1. Stress the importance of teeth. Without teeth, hard foods cannot be chewed and it is hard to pronounce words. 2. Explain how bacteria accumulate on teeth surfaces and form plaque. 3. Go on to explain how if the plaque is not removed, the body initiates a response to protect the body. The tissues become red, inflamed and will often bleed. As a result, the immune system breaks down the infected tissue and bone. Eventually, tooth loss will occur from insufficient anchorage into the alveolar bone. This is known as periodontitis. This topic will be further discussed at the next lesson. 4. Show clients how to brush on typodont. 5. Show clients what their plaque score is by using disclosing solution. 6. Have clients brush their own teeth while looking into a mirror. c. Culminating activities 1. Present visual aids such as posters and pamphlets about plaque formation to further enhance the learning process. 2. Review the topics of plaque and brushing. 3. Post-test 5. Materials and Resources a. Appropriate posters that show proper brushing techniques and healthy/unhealthy gums will be displayed.

b. Typodont, mirrors, disclosing solution, cotton swabs, cups and PPE will be available. c. Grooming area is provided during breakfast time, so this area will be utilized at this time. d. Toothbrushes and toothpaste will be given out to participants to keep. 6. Evaluation Procedures a. Questions about when to brush and how long will be asked along with other appropriate questions. b. Posttest c. At this time, we will assess how well we met our objectives based on the participants answers and the responses on the pretests and posttests.

Pretest 1. What is plaque?

2. How is plaque accumulated or formed on the teeth?

3. How long does it take for plaque to form on the teeth?

4. a.) b.) c.) d.)

What is the recommended length of time for brushing? 5 minutes 1 minute 30 seconds 2 minutes

Posttest 1. What is plaque?

2. How is plaque accumulated or formed on the teeth?

3. How long does it take for plaque to form on the teeth?

4. What is the recommended length of time for brushing? a.) 5 minutes b.) 1 minute c.) 30 seconds d.) 2 minutes

Lesson Plan 2 4/1/14

1. Introductory Statement a. Homeless individuals attending breakfast at Some Other Place Henrys Place, all ages b. Length of time 9-10 AM 2. Objectives a. Individuals can define what periodontitis is and how it occurs (cognitive domain). b. Individuals will display desire to keep teeth (affective domain). c. Participants in program will be able to demonstrate and modify an affective flossing technique (psychomotor domain). 3. Content Outline a. Periodontitis and gingivitis Explain the two types of periodontal diseases. Explain how it affects the gums and teeth. Discuss how gingivitis is reversible and does not always lead to periodontitis. Explain that periodontitis is not reversible due to the breakdown of bone as an inflammatory response from bacterial infection. b. Flossing Explain how it is necessary to remove plaque from between the teeth that brushing cannot remove to eliminate the chance for bacteria to proliferate in the sulcus. 4. Activities which the student will engage a. Initiatory activities 1. Introduce ourselves 2. Introduce the subject of periodontitis/gingivitis and flossing 3. Display pictures of bone loss/tooth loss and red, inflamed gums for participants to see 4. Pre-test b. Developmental activities 1. Stress importance of keeping teeth in order to chew food and pronounce words. 2. Explain how plaque accumulation causes infection in the gums. The gums become red, inflamed and often bleed. This is known as gingivitis. When gingivitis is left to progress, the immune system responds to try to save the life of the affected host and breaks down tissues and bone in the process. When bone is lost, there is less anchorage left to hold the tooth into its socket, therefore becoming loose and eventually fall out. This process is known as periodontitis. 3. Show participants how to use c-shaped flossing technique on the typodont. 4. Disclose individuals before and after flossing. 5. Review brushing techniques from previous session. 6. Have participants brush and floss on their own while looking in mirror. c. Culminating activities 1. Have posters showing proper brushing and flossing on display 2. Review periodontitis and flossing 3. Posttest 5. Materials and Resources a. Appropriate posters that show proper flossing techniques and healthy/unhealthy gums will be displayed.

b. Typodont, mirrors, disclosing solution, cotton swabs, cups and PPE will be available. c. Grooming area is provided during breakfast time, so this area will be utilized at this time. d. Floss will be given out to participants to keep. 6. Evaluation Procedures a. Questions about when to floss and how often will be asked along with why it is important b. Posttest c. At this time, we will assess how well we met our objectives based on their answers and the responses on the pretests and posttests.

Pretest 1. What is periodontitis?

2.

3.

4.

5.

6.

7.

8.

a) Alveolar bone loss resulting from gum disease b) Skin disease c) Hair loss d) Reversible gum disease Does brushing remove all plaque from the teeth? a) Yes b) No c) Dont know Is bleeding normal when it comes to brushing and flossing? a) Yes b) No c) Dont know How many times per week should you floss your teeth? a) 3 b) 5 c) 7 d) 1 How deep is a periodontal pocket? a) 3 millimeters b) 10 inches c) 1 millimeter d) 4 millimeters What does flossing do for our teeth? a) Hurts them b) Removes plaque from between teeth in places brushing cant reach c) Removes all plaque d) Causes them to bleed so it is unnecessary How does infection break down tissue and bone? a) Destroys it on contact b) Causes an immune response that tries to protect the host c) Decays the tissue and bone d) Eats away at it Which teeth should we floss? a) back teeth b) front teeth c) all teeth d) none of them

Posttest

1. What is periodontitis? e) Alveolar bone loss resulting from gum disease f) Skin disease g) Hair loss h) Reversible gum disease 2. Does brushing remove all plaque from the teeth? d) Yes e) No f) Dont know 3. Is bleeding normal when it comes to brushing and flossing? d) Yes e) No f) Dont know 4. How many times per week should you floss your teeth? e) 3 f) 5 g) 7 h) 1 5. How deep is a periodontal pocket? e) 3 millimeters f) 10 inches g) 1 millimeter h) 4 millimeters 6. What does flossing do for our teeth? e) Hurts them f) Removes plaque from between teeth in places brushing cant reach g) Removes all plaque h) Causes them to bleed so it is unnecessary 7. How does infection break down tissue and bone? e) Destroys it on contact f) Causes an immune response that tries to protect the host g) Decays the tissue and bone h) Eats away at it 8. Which teeth should we floss? e) back teeth f) front teeth g) all teeth h) none of them

Lesson Plan 3 4/8/14

1. Introductory Statement a. Homeless individuals attending breakfast at Some Other Place Henrys Place, all ages b. Length of time 9-10 AM 2. Objectives a. Individuals can define what caries is and how it occurs (cognitive domain). b. Individuals will display desire to keep teeth cavity free (affective domain). c. Participants in program will be able to recognize and select foods from a display that can affect the caries process (psychomotor domain). 3. Content Outline a. Caries Discuss how caries process affects tooth development or structure by bacteria causing demineralization (sugar, bacteria, time). Explain the pH level within the mouth and how the acid exposure times relate to the process of caries. Explain how demineralization begins after bacteria consume carbohydrates found on tooth surfaces after consumption of foods and beverages. b. Fluoride Explain that fluoride is a mineral found in drinking water and toothpastes, as well as other sources and what its role is in remineralizing the tooth structure. Explain how insipient lesions can possibly be healed if they are located within the enamel and have not penetrated the dentin of the tooth. c. Nutrition- Explain how it affects pH levels in the mouth and how diet contributes to tooth health. Discuss the types of foods that do not contribute to decay by breaking down within the mouth (starches, proteins, etc.) and those that do (candy, soda, breads). 4. Activities which the student will engage a. Initiatory activities 1. Introduce ourselves 2. Introduce the subject of caries, fluoride, and nutrition 3. Display pictures of cavities for participants to see 4. Pre-test b. Developmental activities 1. Stress importance of keeping teeth in order to chew food and pronounce words. 2. Explain how fermentable carbohydrates can lead to decay. Minerals and nutrients are lost in tooth structure when acid is produced after sugar is metabolized in the presence of bacteria. Since bacteria is always present in the mouth, teeth are at a constant battle when they come into contact with sugar. The acid causes tooth structure to be lost and eventually decay forms. Decay leads to holes or cavities in a tooth. 3. Show participants where cavities begin to form. 4. Explain to participants how decay can lead to further problems such as abscesses. 5. Display pictures of nutritious foods and ones that promote cavities. 6. Explain importance of pH and how water can neutralize the saliva. 7. Enforce the concept of fluoride and its remineralization effects on teeth 8. Review brushing and flossing techniques from previous sessions. 9. Have participants brush and floss on their own while looking in mirror, modify techniques if necessary. c. Culminating activities

1. Have posters on display showing how water and sugar containing drinks affect pH balance in the mouth 2. Review caries process and how a cavity can form 3. Posttest 5. Materials and Resources a. Patient education flipchart, posters and acid exposure times will be on display b. Typodont will be available to show clients where the most vulnerable areas are (pit and fissures) c. Non-alcoholic fluoride containing mouthrinses will be handed out 6. Evaluation procedures 1. Questions about caries process, fluoride and nutrition will be asked 2. Posttest 3. At this time, we will assess how well we met our objectives based on the participants answers and the responses on the pretests and posttests.

Pretest 1. How is a cavity formed?

2.

3.

4.

5.

6.

7.

8.

a) Bacteria b) Sugar c) Vulnerable host d) All of the above What foods cause cavities? a) Bread b) Vegetables c) Meat d) Starches What is the benefit of fluoride and how do we get it? a) Makes our teeth pretty, soft drinks and candy b) Repairs enamel, city water and toothpaste Which of these is nutritious? a) Soda b) Apple c) Chips d) Pretzels What is the outer surface of the tooth called? a) Enamel b) Dentin c) Pulp d) Bone A cavity will repair itself over time without treatment. a) True b) False A tooth treated with fluoride is not as strong as it used to be before acid exposure. a) True b) False What you eat and drink has a major part in the health of your teeth. a) True b) False

Posttest

1. How is a cavity formed? e) Bacteria f) Sugar g) Vulnerable host h) All of the above 2. What foods cause cavities? e) Bread f) Vegetables g) Meat h) Starches 3. What is the benefit of fluoride and how do we get it? c) Makes our teeth pretty, soft drinks and candy d) Repairs enamel, city water and toothpaste 4. Which of these is nutritious? e) Soda f) Apple g) Chips h) Pretzels 5. What is the outer surface of the tooth called? e) Enamel f) Dentin g) Pulp h) Bone 6. A cavity will repair itself over time without treatment. c) True d) False 7. A tooth treated with fluoride is not as strong as it used to be before acid exposure. c) True d) False 8. What you eat and drink has a major part in the health of your teeth. a) True b) False

Lesson Plan 4 4/15/14

1. Introductory Statement c. Homeless individuals attending breakfast at Some Other Place Henrys Place, all ages d. Length of time 9-10 AM 2. Objectives d. Individuals can explain what oral cancer is and what substances cause it (cognitive domain). e. Individuals will display desire to become healthier (affective domain). f. Participants in program will be able to recognize healthy habits (psychomotor domain). 3. Content Outline a. Oral cancer Discuss what is it and where is it usually found. The most prominent areas are the tongue and the palate. b. Substances and habits that cause cancer Give patients a list of side effects and symptoms which can lead to oral cancer due to drugs, alcohol, and tobacco consumption c. Show pictures of what oral cancer can look from brochures provided and discuss the severity and morbidity in the adult population 4. Activities in which the student will engage a. Initiatory activities 1. Introduce ourselves 2. Introduce the topic of oral cancer 3. Use visuals of cancer that has occurred on other individuals and how gruesome it can be 4. Pretest b. Developmental activities 1. Explain how staying healthy can promote a longer, more fulfilling life 2. Explain how oral health contributes to overall health such as systemic diseases and bacterial infections 3. Stress importance of quitting tobacco and alcohol products and how it can improve their life and also save them money in the long-run 4. Provide information on how spitting tobacco can cause cancer along with tooth loss and gum disease 5. Perform oral cancer visual exam on all willing participants c. Culminating activities 1. Provide hotlines, support groups, and pamphlets for tobacco and alcohol cessation 2. Review importance of quitting to stay healthy 3. Posttest 5. Materials and Resources a. Provide pamphlets on oral cancer for participants and common site visuals b. Provide support and information to help participants find a way to quit c. Provide information on substance abuse consequences and places to find help 6. Evaluation Procedures a. Questions about effects of tobacco and alcohol use will be asked b. Posttest c. At this time, we will assess how well we met our objectives based on their answers and the responses on the pretests and posttests. Pretest

1. Tobacco and alcohol can cause oral cancer. a) True b) False 2. Oral cancer is always very noticeable to the naked eye. a) True b) False 3. Where is oral cancer most commonly found? a) roof of mouth b) tongue c) lips d) inside of cheek 4. Which one of these is good for your mouth? a) Smoking b) Drinking alcohol c) Eating carrots d) Dipping tobacco 5. Sun exposure does not cause cancer of the lips. a) True b) False 6. Chemicals found in cigarettes do not include: a) Rat poison b) Eucalyptus c) Car exhaust d) Embalming fluid 7. Dipping tobacco is a safer alternative to smoking cigarettes. a) True b) False 8. Alcohol use when combined with cigarette use can increase your risk of cancer. a) True b) False

Posttest

1. Tobacco and alcohol can cause oral cancer. c) True d) False 2. Oral cancer is always very noticeable to the naked eye. c) True d) False 3. Where is oral cancer most commonly found? e) roof of mouth f) tongue g) lips h) inside of cheek 4. Which one of these is good for your mouth? e) Smoking f) Drinking alcohol g) Eating carrots h) Dipping tobacco 5. Sun exposure does not cause cancer of the lips. c) True d) False 6. Chemicals found in cigarettes do not include: e) Rat poison f) Eucalyptus g) Car exhaust h) Embalming fluid 7. Dipping tobacco is a safer alternative to smoking cigarettes. c) True d) False 8. Alcohol use when combined with cigarette use can increase your risk of cancer. 1. True 2. False

Kelli Adreon

Aimee Martin Oral Health Program Part II

Program Design:

3/25/14 Flyers to promote the program were given to the director a week prior to implementation to post on various locations throughout the facilities. The flyers contained the planned days and a brief overview of the program. On this day, the topics of plaque and brushing were presented. It went as planned, but there was less cooperation than desired. There were about 30 homeless individuals present, and only about ten actually participated. The original intent was to have the participants brush at a sink after being disclosed with solution to show where the plaque accumulated. However, the sinks that were available were in closed off, single person stalls. This was not feasible to use as a teaching area, so, instead, the individuals were disclosed at the front of the room if volunteered to do so. Plaque scores were obtained by visual examination with gloves, mask and adequate lighting. After receiving brushing instructions, the individuals proceeded to one of the stalls to brush the disclosing solution off. An evaluation of the brushing procedures was then performed by visual examination. The two plaque scores obtained were in the good-fair range. More plaque scores would need to be obtained in order to evaluate the population more effectively. Three written pretests were collected and only one posttest. Results from the pretest averaged 58% correct. The posttest that was collected received 100% correct. 4/1/14 On this day, the topics of periodontitis/gingivitis and flossing were discussed. There were fewer individuals present on this day than the previous week. The director explained that this may be due to drug use. He stated that at the first of the month, homeless individuals owed money to drug suppliers or they might be receiving funds to purchase and use drugs. Therefore, many of the previous individuals that were present the first week for breakfast may be absent due to these unfortunate circumstances. There were about 15-20 homeless individuals present for this session. Again, it would have been desirable to be able to teach the participants one-on-one patient education about flossing and gingival diseases, but this was not a practical goal due to limited facility resources available and lack of participation. There was a significant loss of attention for this session. Present individuals seemed unconcerned and less participation occurred. Two individuals were disclosed, one being a returning participant. This individuals plaque score decreased from 1.8 to .5, which is a fair to good change. The other plaque score received was 2.5, falling into the fair range. A multiple choice pretest was given prior to the lesson, which seemed to be much more effective than the previous written one. A pretest average of 5 tests was 70% and no posttests were able to be collected. 4/8/14 On this day, the topics of caries and fluoride were presented to the population. The number of individuals present increased to about the same amount as were present on the first day, with about 30 participants. The individuals were more attentive than the previous session. Fermentable carbohydrates and increasing water intake were stressed at this session, along with buffering the pH of the saliva. It was an obstacle teaching about nutrition to this population, because most of the time, these individuals are unable to receive very much nutrition at all in the form of fruits, vegetables and protein. Their main source of food is usually a cost-effective source such as breads, and grains. Breakfast choices at Henrys Place were oatmeal, donuts and juices. Although nutritional counseling was provided, lack of nutrient

dense resources made it difficult to relate this information to the participants. A pretest was collected and 6 were filled out by participants with an average of 69%. No posttests were able to be collected due to lack of interest towards the end of the session. 4/15/14 On this day, the topic of oral cancer was discussed among the population of homeless individuals. The impact of tobacco and alcohol use was included in the discussion, along with benefits of cessation of these products. There were 25-30 individuals present for this session, and their interest levels were about the same as previous sessions. The subject of oral cancer was not well-received by this population, probably due to current use and addiction problems that contributed to these individuals situations. Surprisingly, there were a few participants interested in oral cancer screenings. Some admitted to not wanting to have knowledge of any suspicious lesions, which was expected due to lack of financial resources available to address the issue. Three pretests were obtained with an average of 84%. Five oral cancer screenings were performed. One out of the five participants presented with a referable lesion. The individual stated that he was aware of the lesion, and that it had been there a few years without resolution. This individual also admitted to tobacco use for 30+ years. A larger number of oral cancer screening volunteers would have been ideal, but this was unobtainable due to lack of interest and/or motivation of homeless individuals present at the session. Program Objectives: Objective #1 The first objective was to improve the oral health of homeless individuals by developing, coordinating, and implementing a community health program to educate our clients on the prevention and control of oral diseases and conditions. This objective was carried out by presenting accurate information to the individuals about the topics of plaque, brushing, gingival diseases, flossing, caries, fluoride and oral cancer. By providing information that the individuals can use to improve their oral health care regimen, it is believed an impact was made. The program was carried out over a four week period with new information at each session. Any questions or concerns the individuals had were addressed at this time. Objective #2 The second objective was to provide a health program for residents and staff of Some Other Place Henrys Place that increases oral health knowledge and skills in maintaining optimal oral health. Attendees of the sessions included staff members and homeless individuals, therefore education was provided to both parties. Skills taught included brushing and flossing on the typodont. The skill performance was measured by a plaque score prior to brushing and visual examination post-brushing. The director stated that a program for the future would be useful in maintaining current oral health care knowledge available to homeless individuals and Henrys Place staff. Objective #3 Increase the utilization of dental services and daily hygiene procedures (brushing and flossing). Address and phone numbers to the LIT dental hygiene clinic were given to a handful of interested participants. The individual that presented with a suspicious oral cancer lesion was made aware of the significance of the finding, and the individuals name and phone number were given to the director who stated measures would be taken to attempt to provide him with the appropriate care. It was difficult to obtain accurate results because findings were sporadic due to unpredictable occurrences of attendance, but a decreased plaque score of one individual was obtained. It may not seem like much, but to be able to reach out to a few participants that have come upon unfortunate living situations is a challenging and rewarding task.

Results, Objective 1: After our presentation, some of the individuals expressed interest in maintaining their brushing and flossing habits in the proper manner to reduce plaque within their mouths. They accepted the toothbrush and floss samples and few claimed they would continue to use them appropriately. Others said they would use the floss inappropriately to tie their belongings together. The individuals displayed some knowledge as to how to brush and floss after they received instructions. They did not cooperate as much as desired so they did not seem that interested in repeating back what plaque was and explaining gum disease back to us. Results, Objective 2: The oral health program was implemented and did offer oral health education to the residents and staff of Henrys Place. Whether or not the health knowledge will be utilized, cannot be confirmed since these individuals are homeless and may not have a steady routine to perform them or have the proper oral health aids or facilities. Results, Objective 3: Information was given as to where cleanings could be done and where they could go to get emergency extractions done. Oral cancer screenings were conducted on volunteers and one positive result was found. Information on this individuals condition was passed onto the director who stated steps would be taken to address the situation. Barriers to care include lack of transportation and financial hindrances, which means, seeking medical help can be difficult for these individuals. Another barrier is the failure to recognize the importance of oral health. Most have the philosophy that, if it does not hurt, it is unnecessary to treat.

Evaluation: A major strength of the program was the overall concept of conveying oral health knowledge to individuals who, otherwise, would not receive any education from other sources. These individuals were subjected to a consistent, weekly lesson offering advice and skill sets they could take with them. Most do not have access to computers or books so this knowledge is invaluable to their health. Weaknesses include lack of participation and interest, and apathy toward the subjects discussed. A more organized setting with smaller groups or one on one instruction and curriculum could occur, would be beneficial to the program. If more low-cost, affordable, or charity services were available to motivate the homeless population, they might be more willing to accept instruction or preventive treatment. If services rendered included an actual appointment date, this might be motivation, as well. They take advantage of most opportunities and samples given them if it proves beneficial and readily available.

Future Site for Oral Health Program: According to the director of Henrys Place, there is a need, and an interest, to continue the program at this location. The homeless population who visit this shelter do not receive any oral health knowledge or dental services, so they are likely to benefit from repeated exposure to preventive information. Many homeless are reached through this intervention facility on a daily basis so any help received is of value. The population at this location is constantly changing so there will always be a need to reach out to new individuals. The staff was cooperative and polite. They made sure that attention was paid to the presentation, if the audience became rowdy. The staff provided us with positive feedback and encouraging thoughts after each visit. The scheduling was ideal

because it was during the breakfast hours when clients were seated in a main room and could avert their attention to the speakers. The amount of time allotted was also appropriate for their attention spans. If the presentation was made any longer, interest could have been completely lost. Learning Value: Much was learned about homeless populations. It is important to be patient and nonjudgmental and understanding of the difficulties this population faces on a daily basis. Many of their circumstances may not be known, however, assumptions can be made that they have very limited oral health knowledge or access to care. Compassion must be offered to clients in such delicate situations and help encourage their involvement in order to make a genuine difference in their lives. It was learned to never take advantage of daily opportunities given to increase knowledge, or proceed to live as though it is not possible to fall into the same position as those less fortunate. Collaboration: Throughout the development of this program, teamwork was applied in the construction of a resource list, budget, lesson plans, collection of data, implementation, and evaluation. As the lessons were conducted, each presenter built off the previous presenters knowledge base to create a well-rounded speech. What one presenter did not present as strongly, the other supplemented additional information to convey to the audience. As a result, complete and thorough information was provided at each lesson. This process was extremely helpful to the presenters because it was exponential in building confidence in an uncomfortable situation. The uncertainty that follows the target population can be more easily accepted when a partner is present to provide assistance. Together, two educated minds can offer more guidance and enlightenment to a severely displaced community.