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Appendices to final report

Refugee Oral Health Sector Capacity Building Project

Prepared by Thuy Nguyen, Sue Casey & Stephanie Rich On behalf of the Project Advisory Group at the Victorian Refugee Health Network, Foundation House info@refugeehealthnetwork.org.au

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List of Appendices

Appendix 1: Program logic framework ...................... 3

Appendix 2: Oral Health Factsheet 1 ......................... 8

Appendix 3: Oral Health Factsheet 2 ........................ 10

Appendix 4: Model of care:...................................... 12

Appendix 5 – Identified Resources – publicly available

............................................................................... 13

Appendix 6: TEP Curriculum ..................................... 19

Appendix 7: Call for Expression of Interest Letter ..... 20

Appendix 8: Baseline Survey .................................... 21

Appendix 9: Follow up Survey .................................. 26

Appendix 10: 3-month Follow up Survey .................. 33

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Appendix 1: Program logic framework

PURPOSE: To strengthen the Victorian public oral health service capacity to appropriately

and effectively respond to clients of refugee and asylum seeker background

Objective/Strategy/Output Project Phase Indicators Means of Verification

OBJECTIVE 1 To improve the

knowledge, attitude and practices of

dental health staff and services working with clients of refugee and asylum seeker background in Victoria.

Strategies and tasks to achieve this objective will be informed by the needs analysis.

Strategy/Activity 1.1 Conduct a

mini needs-analysis with various Victorian public dental health services servicing refugee and asylum seeker clients to determine gaps in knowledge, skills, systems, and support required.

Phase 1:

Information gathering & needs determination

A need for, or gap in information, resources, and support for public dental staff and services working with clients of refugee and asylum seeker background.

Online survey

(via Survey Monkey to collect data from refugee oral and allied health workers in the top 10 LGA regions in Victoria (including data on current or previous systems, processes, resources, evaluation, professional development and support).

Output 1.1 A report including identified needs, themes and priorities for working with clients of refugee and

asylum seeker background who are accessing public dental health services.

Strategy/Activity 1.2 Establish a

project advisory group which will assist sharing the knowledge of key stakeholders, and which will provide guidance throughout major phases of the project.

Phase 1: Information gathering & needs determination

Note: PAG will be established during this initial phase, but will provide input throughout the different phases addressing all 3 objectives

An interest for, or a need of, expertise in refugee and asylum seeker oral health – participation in PAG

Record the number of meetings held and attendance of members at advisory group meetings

Observe and record the richness and usefulness of project activities and outputs

Output 1.2 An established and ongoing project advisory group (PAG), for project direction and also a network for other complimentary work.

Strategy/Activity 1.3 Conduct a

literature review to identify oral health programs and concerns around access, barriers and facilitators of oral health care among refugee and asylum seeker clients

Phase 2: Source and review of existing resources & identification of gaps

Refugee oral health gaps identified

Existing resources located

A systematic review with search terms including,

Oral/dental health

Refugee/asylum seeker

CALD/migrant

Output 1.3 A progress report of current concerns among dental health services around access, barriers and

facilitators of oral health service with clients from refugee and asylum seeker background

Strategy/Activity 1.4 Review

existing oral health policy and oral Phase 2: Source and review of

Existing resources identified & reviewed

A desk-top review, including from sources from:

health promotion resources for working with refugees and asylum seekers (local, state, national and international).

existing resources & identification of gaps

Needs (identified in phase 1) mapped against existing resources and thus information gaps identified

EACH

Tooth Tales (look at sharing resources)

Health Translations Directory

NSW Refugee Health Service

NSW Multicultural Health Communication Service - Dental Care

Centre for Culture, Ethnicity and Health (CEH)

Output 1.4 A progress report including current programs, policies, and resources available to dental health

services who work with clients from refugee and asylum seeker background

Strategy/Activity 1.5 Communicate

and share information at a central online site: the Victorian Refugee Health Network Website (including links to the DHSV website and potentially other relevant sites)

Phase 3 & 4: Promote good practice in refugee and asylum seeker oral health; systems and service development with oral health services and oral health workers

Resources uploaded onto Victorian Refugee Health Network website

The number and quality of information and resources that will be available on the VRHN website

The number of dental staff and referrals who access/refer to resources on the VRHN website

(the reach)

Output 1.5 A central website with refugee and asylum seeker oral health information, resources and links for

referral, engagement and care.

Strategy/Activity 1.6 Conduct a

targeted education program (TEP) with public dental agencies who services clients of refugee and asylum seeker background

Note: Training will be informed by the mini-needs analysis, review of existing gaps in resources, literature review, outcomes/feedback from the oral health forum, and work of the project advisory group (see strategies 1.1 & 1.2)

Phase 3 & 4: Promotion of current approaches and best practice in refugee and asylum seeker oral health; systems and service development with oral health services and oral health workers

Learning & professional development conducted with interested oral health care staff and services located in LGA’s with high refugee settlement

The quality of TEP can be evaluated through a process evaluation after each module and group discussions.

The effectiveness of TEP will be measured by comparing responses from participating dental service staff pre, post and 3-mo post-delivery.

Record of expressions of interest for TEP participation

Output 1.6 Oral health services and staff more confident and knowledgeable around the practices of an

accessible service (evidenced by evaluation)

OBJECTIVE 1 To promote good

oral health practice among community dental agencies working with clients of refugee and asylum seeker background, including survivors of torture

Strategies and tasks to achieve this objective will be informed by the needs analysis.

Strategy/Activity/Output Project Phase Indicators Means of Verification

Strategy/Activity 2.1 Conduct a

mini needs-analysis (refer to strategy 1.1)

Phase 1: Information gathering & needs determination

A need for, or gap in info, resources, and support good practice among services working with refugee and asylum seeker clients

A literature review & survey (see strategy/activity 1.1)

Output 2.1 A progress report identifying good dental health practice, policy and standards for services working

with clients of refugees and asylum seekers, including survivors of torture.

Strategy/Activity 2.2 Develop

useful resources that facilitate the work of oral health staff and services working with clients from refugee and asylum seeker background and their communities.

Phase 3 & 4: Promotion of current approaches and best practice in refugee and asylum seeker oral health; systems and service development with oral health services

Learning & professional development resources created in collaboration with PAG and participating services that aims to address gaps identified in Activities 1.1-1.5

Feedback on resources developed from PAG and participating public dental service staff.

(impact evaluation – feed back from clients, including FGD, questionnaire) – Southern Health

Output 2.2 Tangible tools, including factsheets and model of care, and updating oral health information for the

Refugee Health Guide, to assist oral health staff and services working with clients of refugee and asylum seeker background.

Strategy/Activity 2.3 Conduct a

targeted education program (TEP) that addresses knowledge, attitude and practices of public dental agencies who services clients of refugee and asylum seeker background, including survivors of torture.

Note: Training will be informed by the mini-needs analysis, review of existing gaps in resources, literature review, outcomes/feedback from the oral health forum, and work of PAG(see strategies 1.1 & 1.2)

Phase 3 & 4: Promotion of current approaches and best practice in refugee and asylum seeker oral health; systems and service development with oral health services and oral health workers

A change in knowledge, attitude and practice among

oral health care staff and services located in LGA’s with high refugee settlement

Increased knowledge

Positive attitude

Good practice

Self-administered structured questionnaire (comparing responses from participating dental service staff pre, post and 3-mo post delivery.)

Group discussion in team meeting

Output 2.3 A tailored and effective targeted education program available for public dental agency/cies working

with clients of refugee and asylum seeker background, including survivors of torture.

OBJECTIVE 3 Increase the

capacity of oral/dental health staff and services to establish supportive systems that assist them to work more appropriately and effectively with refugee and asylum seeker clients in their local communities.

Strategies and tasks to achieve this objective will be informed by the needs analysis.

Strategy/Activity/Output Project Phase Indicators Means of Verification

Strategy/Strategy 3.1 Conduct a

mini needs-analysis of current systems in place when working with refugee and asylum seeker clients, in various oral health services (see strategy 1.1)

Phase 1: Information gathering & needs determination

A need for, or gap in supportive systems among dental and related services working with clients of refugee and asylum seeker

A literature review & survey (see strategy/activity 1.1)

background.

Output 3.1 A progress report outlining current supportive systems and frameworks and gaps that need to be

addressed for fluid dental care with clients of refugees and asylum seekers, including survivors of torture.

Strategy/Activity 3.2 Establish a

project advisory group which will assist sharing the knowledge between related stakeholders, including GP’s, dental clinicians, the Department of Health, and settlement services.

Phase 1: Information gathering & needs determination

Note: Advisory group will be established during this initial phase, but it will provide guidance/input throughout the different phases addressing all 3 objectives

An interest for, or a need of, expertise in refugee and asylum seeker oral health – participation in PAG

Record the number of meetings held and attendance of members at advisory group meetings

Observe and record the richness and usefulness of project activities and outputs

Output 3.2 An established and ongoing project advisory group (PAG), for project direction and also a network for

other complimentary work.

Strategy 3.3 To create and collate

resources that facilitates dental agencies working with clients of refugee and asylum seeker background, including survivors of torture.

Note: This will be informed by the mini-needs analysis, review of existing resources, literature review, and work of the project advisory group (see strategies 1.1 & 1.2)

Phase 3 & 4: Promotion of current approaches and best practice in refugee and asylum seeker oral health; systems and service development with dental services

New service-orientated resources developed, including resources that may address issues such as identifying refugee clients, the use of interpreters, reminder calls and block bookings, referral protocols and oral health promotion translated materials.

Feedback gathered from oral health staff and services

Feedback from PAG

Output 3.3 List of resources supporting organisational development for dental services working with their target

group, specifically, clients of refugee and asylum seeker background.

Strategy/Activity 3.4 Conduct a

targeted education program (TEP) that deconstructs the organisational structure and support of a dental service and works with that service to build a plan addressing their key priorities

Note: Training will be informed by the mini-needs analysis, review of existing gaps in resources, literature review, outcomes/feedback from the oral health forum, and work of the project advisory group (see strategies 1.1 & 1.2)

Phase 3 & 4: Promotion of current approaches and best practice in refugee and asylum seeker oral health; systems and service development with oral health services and oral health workers

A new work plan including how to appropriately and efficiently work with clients of refugee and asylum seeker background

Policies and systems in place to support staff delivering services with clients of refugee and asylum seeker background

Self-administered structured questionnaire to gather the perception of dental health staff re: how confident and supported (comparing responses from participating dental service staff pre, post and 3-mo post-delivery.)

Group discussion in team meeting (assuming it will not be biased in group setting/desire to please researcher)

Output 3.4 A TEP that addresses a whole-of-dental-service change and support for working with clients of

refugee and asylum seeker background.

Strategy/Activity 3.5 Communicate

refugee and asylum seeker oral Phase 4: Systems and

New edition of ‘Promoting Refugee

Number of GP guides distributed (assuming all

health policy to referral groups, including GP’s, RHN, CA and settlement workers.

Activity: Update and distribute information in the Promoting Refugee Health Guide (for GPs) among other refugee oral health resources

service development with oral health services and oral health workers

Health’ guide will include updated dental health information and resources.

Resource development & on central website

Increase in GP/RHN/CA/settlement worker referrals among public dental agencies

reads the oral health section)

Number ‘clicks’ and downloads around refugee oral health resources from the VRHN website

Data collection via Titanium, agency-dependent

Output 3.5 Range of resources readily available for oral health services and practitioners.

Appendix 2: Oral Health Factsheet 1

Appendix 3: Oral Health Factsheet 2

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Appendix 4: Model of care:

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Appendix 5 – Identified Resources – publicly available

1. Refugee Oral Health - Policy & Guidelines documents Source Title Hard copy/Online On VRHN

website

Vic DoH Eligibility and priority access

for public dental services

policy

March 2010

Link on VRHN Yes

Vic DoH Public dental fees policy, July 2010

Link on VRHN Yes

National Advisory Committee on Oral Health

Healthy Mouths Healthy Lives: Australia’s National Oral Health Plan 2004-2013

Online:

http://www.health.vic.gov.au/dentistry/publications/oralhealth.htm

Yes

Vic DHS Refugee health and wellbeing action plan

Link on VRHN Yes

Vic DHS State-wide oral health promotion strategic plan 2008-2012

http://www.dhsv.org.au/download/0f08d8d0/dhsv-statewide-oral-health-promotion-strategic-plan-2008-2012.pdf

No

Victorian Government

Victorian Multicultural Commission

Using Interpreting Services: Victorian Government Policy & Procedures

http://www.multicultural.vic.gov.au/images/stories/pdf/2383%20vmc%20interpreter%20manual%20web.pdf

No

Vic DoH Hume Region – Integrated Oral Health Care Plan

http://www.dhsv.org.au/about-us/reports-and-publications/regional-oral-health-plans/

No

Vic DoH Gippsland Oral Health Plan March 2009

http://www.dhsv.org.au/about-us/reports-and-publications/regional-oral-health-plans/

No

2. Resources – REFUGEE ORAL HEALTH

Source Title Hard copy/Online On VRHN site

DHSV DHSV – Translated materials:

(In Arabic, Chinese, English, Macedonian, Somali,

Turkish and Vietnamese)

Information on public dental services (PDF,

864KB)

Visitor's guide to RDHM (PDF, 375KB)

Guide to day surgery (PDF, 1.72MB)

Protecting your privacy (PDF, 311KB)

How to brush chart (PDF, 3.28MB)

http://www.dhsv.org.au/oral-health-resources/translated-materials/

Yes

Eat well tip card (PDF, 851KB)

Drink well tip card (PDF, 709KB)

Clean well tip card (PDF, 769KB)

Tooth tips: 0 - 12 months (PDF, 220KB)

Tooth tips: 12 - 18 months (PDF, 234KB)

Tooth tips: 18 months - 6 years (PDF, 192KB)

DHSV Culturally and Linguistically Diverse Communities – Resource Kit

http://www.dhsv.org.au/oral-health-resources/guides-and-resources/#Culturally

No

NSW Refugee Health Service

Dental health of Refugees – for Community workers

http://www.sswahs.nsw.gov.au/sswahs/refugee/

Yes

NSW Refugee Health Service

Oral health of Refugees – for dental professionals

http://www.sswahs.nsw.gov.au/sswahs/refugee/

Yes

NSW Multicultural Health Service

Translated oral health materials:

1. Caring for babies' teeth

(Arabic, Assyrian, Chinese Traditional, English, Farsi, Indonesian, Khmer, Korean, Punjabi, Samoan, Serbian, Spanish, Tamil, Thai, Tongan, Turkish, Vietnamese).

2. Dental care for older people

(Arabic (pdf), Chinese Traditional (pdf), Croatian (pdf), English (pdf), Greek (pdf), Italian (pdf), Macedonian (pdf), Maltese (pdf), Russian (pdf), Spanish (pdf), Turkish (pdf), Vietnamese (pdf)

3. Getting older? Why your teeth and gums are important for good health

(Arabic (pdf), Bosnian (pdf), Chinese Traditional (pdf), Croatian (pdf), English (pdf), Greek (pdf), Italian (pdf), Khmer (pdf), Korean (pdf), Lao (pdf), Macedonian (pdf), Portuguese (pdf), Russian (pdf), Serbian (pdf), Sorani (pdf), Spanish (pdf), Thai (pdf), Turkish (pdf), Vietnamese (pdf))

4. How to save money on dental bills

(Arabic (pdf), Chinese Traditional (pdf), Croatian (pdf), English (pdf), Italian (pdf), Khmer (pdf), Korean (pdf), Lao (pdf), Macedonian (pdf), Portuguese (pdf), Russian

http://www.mhcs.health.nsw.gov.au/topics/Dental_Care.html

Hardcopies are downloadable from website.

No

(pdf), Serbian (pdf), Spanish (pdf), Thai (pdf), Turkish (pdf), Vietnamese (pdf))

5. Keeping your teeth - whatever your age

(Arabic (pdf), Bosnian (pdf), Chinese Traditional (pdf), Croatian (pdf), English (pdf), Italian (pdf), Khmer (pdf), Korean (pdf), Lao (pdf), Macedonian (pdf), Portuguese (pdf), Russian (pdf), Thai (pdf), Turkish (pdf), Vietnamese (pdf))

6. Lift the lip

(Arabic (pdf), Chinese Traditional (pdf), Dinka (pdf), English (pdf), Farsi (pdf), Hindi (pdf), Japanese (pdf), Khmer (pdf), Korean (pdf), Lao (pdf), Pushto (pdf), Samoan (pdf), Somali (pdf), Thai (pdf), Turkish (pdf), Vietnamese (pdf))

7. Lift the lip – dental service poster

(Arabic (pdf), Chinese Traditional (pdf), English (pdf), Farsi (pdf), Hindi (pdf), Korean (pdf), Turkish (pdf))

Boston Center for Refugee Health and Human Rights

Caring for Refugee and Survivors of Torture – Online Course:

Overview of Medical Problems Types of Torture Torture-Related Physical Signs and Symptoms Oral Health Exam Oral Health Presentation

http://www.bcrhhr.org/pro/course/oralhealth/oral.html

Yes

Department of Health

Evidence-based oral health promotion http://docs.health.vic.gov.au/docs/doc/Evidence-based-oral-health-promotion-resource-(2011)

No

3. Resources –CULTURAL COMPETENCY

Source Title Hard copy/Online On VRHN site

Vic Foundation for survivors of Torture

Caring for Refugee Patients in General Practice

www.refugeehealthnetwork.org.au

Hardcopy may be ordered

Yes

Centre for Culture, Ethnicity & Health (CEH)

Tip Sheets on Cultural Competence:

A framework for cultural competence

Introduction to cultural competence and the framework used to measure it

http://www.ceh.org.au/culturalcompetence.aspx

No

Organisational values

How to demonstrate the value that your organisation places on cultural competence Governance

How to embed cultural competence in your advisory bodies, policies, standards and goals Planning, monitoring & evaluation

How to ensure that programmatic and operational plans address cultural competence issues, and track and assess your progress Communication

How to support the effective and culturally appropriate exchange of information between your organisation and its clients, and between staff members Staff development

How to equip staff and service providers with the attitudes, knowledge and skills needed to deliver culturally competent services Organisational infrastructure

How to identify and allocate the resources needed to plan, deliver and evaluate culturally competent services Services and interventions

How to deliver or facilitate clinical, public health or health-relayed services in a culturally competent manner

Hard copies on file

Centre for Culture, Ethnicity & Health

Communicating with clients with low English proficiency

http://www.ceh.org.au/downloads/comm_clients_low_english.pdf

No

Centre for Culture, Ethnicity & Health

Interpreter Tipsheets:

Developing a comprehensive language services

response

This tip sheet covers the key elements of planning

for language services

Assessing the need for an interpreter

This tip sheet will help you determine whether an

interpreter is needed to work with a particular client

Arranging an interpreter

This tip sheet covers the language and cultural

considerations for booking an interpreter.

Working with interpreters

This tip sheet assists you to plan and conduct a

http://www.ceh.org.au/mghp/problem_gambling_resources/mghp-using-interpreters.aspx

No

session with an interpreter.

Regional Information and Advocacy Council

(RIAC)

Language Services Toolkit http://www.riac.org.au/GVPCP/

Yes

DHS – Health Translations Directory

Find Your Language Tool

Translated Health information

http://www.healthtranslations.vic.gov.au/bhcv2/bhcht.nsf/pages/find_your_language?open

http://healthtranslations.vic.gov.au/bhcv2/bhcht.nsf

No

No

DoH Community Health Priority Tools http://www.health.vic.gov.au/communityhealth/demand/prioritytools.htm

Yes

NSW Refugee Health Service

Guidelines for working with interpreters Online:

Victorian Transcultural Psychiatry Unit (VTPU)

Working Effectively with Interpreters Kit:

- Quick Guide to working with Interpreters in Mental Health Settings

- Working with Interpreters in Mental Health Settings - guidelines

Online:

http://www.vtpu.org.au/resources/index.html

Yes

Eastern Health

CUE CARDS in community languages:

- Resource not to be used in lieu of interpreters, but as an additional aid to be used by clients to communicate simple needs, and by professional to indicate simple instructions/concepts.

http://www.easternhealth.org.au/services/cuecards/default.aspx#cuecards

Yes

NZ Waitemata District Health Board -

CALD Toolkit http://www.caldresources.org.nz/info/info/CALD-Toolkit_WDHB.pdf

No

Dental Council of NZ

Cultural Competence Statement and Indicators

http://www.mcnz.org.nz/portals/0/guidance/cultural%20com

No

petence.pdf

4. Resources –Interactive Learning

Source Title Hard copy/Online Available on VRHN site

Aboriginal Interpreter Services (AIS)?

OneTalk (Northern Territory Aboriginal Interpreter Service)

Manual available online http://www.lowitja.org.au/crcah/one-talk-240907

Or share drive: Refugee health network\oral health\ Dental Sector Capacity Building Project - Refugee Oral Health\oral health resources\RESOURCES – Innovative & Interactive

No

ECHO (Minnesota)

Healthy Teeth for Children

http://www.echominnesota.org/library/healthy-teeth-children

(available in Amharic; Arabic; English; Khmer; Karen; Oromo; Russian; Somali; Vietnamese; Lao; Spanish; Hmong)

No

5. Resources –Interactive Learning

Source Title Hard copy/Online Available on VRHN site

Doutta Galla Talking about teeth

Planned to be posted on DG website in 2012) No

McCaughy Centre & Merri Community Health Service

Teeth Tales http://www.mccaugheycentre.unimelb.edu.au/research/current/intergenerational_health/teeth_tales

No

Appendix 6: TEP Curriculum

Appendix 7: Call for Expression of Interest Letter

Seeking Expressions of Interest for participation in a targeted education program Working with people from refugee backgrounds for oral health services

Background The Victorian Refugee Health Network, auspiced by the Victorian Foundation for Survivors of Torture (Foundation House), is working in partnership with Dental Health Services Victoria (DHSV) to implement a Department of Health funded Refugee Oral Health Capacity Building Project. The Project is being overseen by an Advisory Group that includes oral health services and practitioners, researchers, settlement services, DHSV and Department of Health.

One of the key activities of this project is the development and evaluation of a targeted education program in refugee oral health. A preliminary curriculum has been developed based on a sector needs analysis undertaken in early 2011. The final curriculum will be developed in partnership with participating oral health services.

Content overview The intention with this targeted education program is to take a ‘whole-of-service’ approach that includes providing all staff with frameworks for understanding the refugee experience and skills in working cross-culturally, with additional module(s) for clinicians to develop a greater understanding and skills development in refugee health issues, the impact of torture and trauma, impact of detention and asylum seeking process and possible sequelae in oral health care and the use of reflective exercises to consider facilitators and barriers to accessing oral health care for refugee background communities. A mix of didactic, observational and experiential learning will be used.

Selection Criteria We are seeking one or two agencies to participate in this program who fit the following criteria:

1. Service is located in an area with significant refugee settlement 2. Is able to commit to whole-of-service participation (e.g. management, administration and clinicians) 3. Interested in reflecting on current practice and potential barriers and facilitators to services for refugee background communities as an outcome of participation 4. Able to commit to 4-6 x 3 hours modules (timing to be determined and dependent upon staff roles) 5. Participate in pre and post evaluation 6. Have the ability to relieve staff for the learning series for a pre-determined amount of time (preferably between March – May 2012)

Presenters and facilitators will be experts in refugee health, oral health and cross-cultural health promotion,

and torture and trauma counselling. There will be some flexibility with the content of the curriculum and time commitment depending on the needs of the participating agency. There will be no cost to participating agencies.

To apply

To express your interest to participate, please complete the form electronically through: http://www.surveymonkey.com/s/exp_of_interest

Please forward expressions of interest by Wednesday, 1st February, 2012. _______________________________________________________________________________

For additional information, please contact:

Thuy Nguyen Sue Casey

Refugee Oral Health project worker Manager, Health Sector Development

E: nguyent@foundationhouse.org.au E: caseys@foundationhouse.org.au

T: 9389 8929 T: 9389 8911

Appendix 8: Baseline Survey

Appendix 9: Follow up Survey

Appendix 10: 3-month Follow up Survey