Scottish Oral Health Improvement Homelessness Programme (Smile4life)

In March 2005 the then Scottish Executive produced a set of Health and Homelessness Standards, aimed at ensuring that NHS Boards within Scotland gave special consideration to improving the understanding, planning and treatment of people experiencing homelessness within their Board areas.  Improving the oral health of homeless people in Scotland was identified as a priority in An Action Plan for Improving Oral Health and Modernising NHS Dental Services (2005), which stated that it would be desirable for NHS Boards to develop and implement oral health care promotion for priority groups of ‘adults most in need’.  Homeless people were highlighted as one of these priority groups.

In 2007, when monies became available to develop oral health improvement programmes for priority group patients, including homeless people, a successful proposal was put to Scotland’s  Chief Dental Officer. The proposal was called ‘Smile4life’, and was submitted by a consortium of seven NHS Boards.

The Scottish Government’s commitment to improving the oral health of homeless people in Scotland was further strengthened in June 2012 by the publication of the National Oral Health Improvement Strategy for Priority Groups. The Strategy made various recommendations for homeless people, including those relating to dental referrals and the provision of oral health education. It was also recommended that staff in the homelessness sector should play a key role in assisting homeless people to improve their oral health.

Aim and objectives

The aim of the Smile4life proposal was to facilitate the development, implementation and evaluation of evidence-based oral health preventive programmes for homeless (roofless and houseless) people throughout Scotland.

The specific objectives were to:

• conduct a needs assessment to inform the current oral health and preventive oral health needs from the homeless (roofless and houseless) clients’ perspective (Smile4life oral health survey and qualitative exploration).
• conduct a needs assessment as viewed from health professionals’ perspective.
• scope current models of preventive service and practice for homeless populations in Scotland.
• develop and evaluate an evidence-based oral health care preventive package tailored to the specific needs of homeless (roofless and houseless) populations in Scotland.

Publications

• Oral health promotion and homelessness: A theory-based approach to understanding processes of implementation and adoption
• Decayed and missing teeth and oral-health-related factors: Predicting depression in homeless people
• Homeless in North and West Belfast: an oral health needs assessment