Dental Day Highlights Need for Affordable, Accessible Care

On Wednesday, October 9th, the UAB School of Dentistry hosted its first UAB Dentistry Cares Community Day, or simply Dental Day, as it came to be known in our office. For the event, a dedicated team of over 500 volunteers from the UAB Schools of Dentistry and Nursing, Cahaba Valley Health Care, and local dentists, health agencies and companies provided free services to more than 350 people. The UAB School of Dentistry coordinated the event with One Roof and Cahaba Valley Healthcare, a local non-profit dedicated to providing access to healthcare for underserved populations in the area.

This was the first year that UAB hosted such an event and the response from patients, participating member agencies, and volunteers has been overwhelmingly positive. Aside from a few hiccups due to the large number of participants, the clinic ran smoothly and volunteer dentists and students were able to treat everyone who showed up, including many walk-up patients that we did not want to turn away. By 9 AM, over 110 people registered for the clinic; the 250-patient goal was exceeded by noon. The services provided included cleanings, extractions, and restorations. Patients also received counseling about proactive and preventative oral health care, as well as medical history reviews, blood pressure checks, and oral cancer screenings. The clinic finally finished admitting patients shortly after 2 PM, and several of the volunteer dentists offered further services.

Dr. Conan Davis, chair of UAB Dentistry Cares and director of community collaborations, expressed to One Roof that he was extremely satisfied with how the clinic went, and that the school is already considering making it an annual event. Dr. Michael Reddy, Dean of the School of Dentistry, stated that the clinic is one of only a few like it in the country being held this year.  Dr. Reddy and Dr. Davis believe that the UAB community of health care professionals is obligated to serve the greater Birmingham community in the best way they know how, with access to affordable treatment.

According to Tyler Greer of UAB News, the National Institute of Dental and Craniofacial Research reports that the majority of adults aged 20 to 64 who are living below the federal poverty level say their teeth are in only fair condition or worse.  Fewer than 50 percent of these adults have routine dental checkups, and in Alabama, Medicaid provides no dental coverage for adults, making access to care even more difficult for low income families. Dr. Reddy said that treatments for conditions requiring even minor dental work is practically inaccessible for families and individuals not covered by a private insurer.  Often, the only time they can see a dentist is at charitable events and clinics.  The School of Dentistry and Cahaba Valley Healthcare hope events like these with such large turnouts will highlight this lack of accessibility to basic care in our community.

We at One Roof were very honored to be given an opportunity to help provide care for clients of member agencies, and we will do all we can not only to ensure the continuation of the clinic, but to improve it as well. If you participated in the event, please send feedback to our office about your experience and ways to make it better next time. Thanks again for all you do!

Safer Spaces: Transgender 101

On Friday October 4, One Roof hosted a Transgender 101 Workshop for our member agencies. Our aim: to answer the call of case workers, social workers, and other representatives from our member agencies who’ve repeatedly expressed that they want to know more about the issues facing transgender folks experiencing homelessness. Our members want to know how to best serve their transgender clients, how to best meet their needs, and we want to equip and empower them to do so.

The workshop was led by Dr. Jay Irwin, a Medical Sociologist in the department of Sociology & Anthropology at the University of Nebraska at Omaha. Dr. Irwin, a native Alabamian who earned his PhD from UAB, specializes in LGBT health, transgender identity, sexuality, mental health, and homelessness. He was very excited to hear of our concern for the transgender community and happy to help our community of service providers better understand transgender issues.

So, how do we best meet the needs of our transgender clients? A short answer and the most important take-a-way from this workshop: we treat transgender clients with respect, care, and compassion without judgment. But what does this respect, care, and compassion look like? How do we put this into practice and policy? Is this any different from the way we serve our non-transgender (cisgender) clients?

We at One Roof believe respect starts with language. Using appropriate and preferred language when talking to and about a client is key. One Roof’s mission is to equip and empower our community to prevent and end homelessness through advocacy, education, and coordination of services. Empowering our community includes empowering our transgender clients by advocating for the use of appropriate and preferred language on their behalf. If we simply ask a transgender person (or any person, really) their preferred gender pronoun, we give them the choice to let us know how they want to be identified and talked to. If we use a client’s preferred pronoun, we show them that we see them and hear them, that we are invested in their individual experience and want to serve them the best way possible. Asking about and using a client’s preferred language also allows them to maintain some sort of control in their life, to have a say in how they’re perceived. For our clients, some of the most vulnerable folks in our community, this kind of empowerment is crucial. Is this something we can put into practice?

We also believe respect extends to bathrooms. Using a public bathroom is stressful enough for many folks. Consider the vulnerable nature of the community we serve and consider how, for a transgender person, trying to figure out the best bathroom situation can come down to personal safety. So how can we respect our clients? How can we make our facilities safe? Dr. Irwin suggested that we ask clients where they feel most comfortable using the bathroom and honor their experience. You might have the following questions: What do we do if a transman has a negative experience using a men’s bathroom in one of our facilities? If a transwoman has a negative experience using a women’s bathroom? Well, what if, instead of basing practices around the assumption that negative experiences will happen based on a gender identity that may be challenging to some, we instead promote respect of all clients and emphasize and enforce zero tolerance policies for all types of harassment and violence? What if we offer and advertise safe bathrooms? We believe that honoring the experiences of all clients both shows and encourages respect. Is this something we can put into practice?

Now a more complicated issue: how do we safely place transgender clients in an emergency shelter or transitional housing? How do we meet their housing needs when many of our options are communal and gender-specific? Dr. Irwin presented the following best practice: if a person identifies as a woman, they receive services at a women’s facility; if a person identifies as a man, they receive services at a men’s facility. We believe this shows our clients that they are seen and heard, that we’re invested in their individual experience. We at One Roof also acknowledge the complications that might arise from this best practice. We know the realities of violence against transgender persons: transgender folks experience more violence of all kinds than non-transgender persons, especially transwomen of color. The possibility of violence against transgender clients is not something we can or will ignore when making housing decisions. But we have to think deeper about this. We have to ask if we’re projecting our fears when making housing decisions. Are we making decisions based on the potential negative behavior of others because a client’s gender identity may be challenging to them? What if we focus more on the behavior instead of the identity? If we address problematic behavior comprehensively, (again, promoting respect of all clients and emphasizing and enforcing zero tolerance policies for all types of harassment and violence), then we can provide safer spaces for our transgender clients. Is this something we, as a community of service providers, can do?

We at One Roof acknowledge that our suggestions here may seem idealistic rather than practical—but what if this is a time to be idealistic, to want and believe in safer spaces and therefore make safer spaces. We turn to you now, our community of service providers and the greater Birmingham community, and ask: How can we put this into practice? How can we promote and, really, demand respect for not just transgender folks experiencing homelessness, but all of our clients? How can we, through advocacy, education, and coordination of services, make our spaces safer for everyone?


Josh Helms is an AmeriCorps member serving at One Roof as the Capacity Building Assistant.

Why it should bother YOU that a person who is homeless cannot get medical care

A clinic waiting room is shown at Cooper Green Mercy Hospital in Birmingham, Ala., Friday, March 23, 2012. (The Birmingham News/Mark Almond)

Cooper Green has not left the headlines since Inpatient Care and the Emergency Room were closed last year. A large physician’s group is now speaking out about poor people not receiving medical services — a situation they say will raise medical costs for everyone.

However, a recent scholarly article published in the Journal of Urban Health tells an equally frightening story….a story that has been going on for more than 10 years.  The following news articles are as recent as April 26, 2013:

The Journal of Urban Health tells us that in 2010, a group of researchers set out to understand more about a previous study showing that the homeless of our community have problems accessing medical care. The 2010 study showed:

  1. that the problems with getting care are real and that they remain severe

  2. that problems pertain to all types of health care, even the most basic general care that charity clinics and federally qualified health centers get funds, grants and donations to provide

  3. that the problems with getting care are especially difficult at the federally funded Birmingham Health Care, and at the primary care clinics at Cooper Green

The study shows that 15% of homeless people who went to Birmingham Health Care could not get care, and that, at the Cooper Green clinics, 13% could not get care. The study shows that, from 1995 to 2005, the percentage of homeless persons in Birmingham with unmet health care needs rose from 32% to 54%, meaning that on at least one occasion, these individuals were unable to access a form of health care they needed even though they tried.

Why should it bother YOU that a person who is homeless cannot get medical care? Well, first thing is that One Roof believes it is morally the right thing to do to see that basic medical care is provided for ALL citizens. Additionally, it is fairly disturbing that we live in one of the arguably greatest medical centers anywhere, and people who have lived here for their entire lives cannot access basic medical care.  However, if you don’t care about those reasons, let me share another reason:  money. The links below are just three short articles out of the hundreds of studies that show routine care for chronic conditions is far less expensive than emergency care.

The bottom line of all these studies is that medical costs incurred when getting routine medical care in a doctor’s office or clinic setting are much, much lower than going to the emergency room. Logically, a person who is unable to receive the needed routine care in a clinic is unlikely to be able to afford the emergency room care. If the emergency room care is not paid for by the patient, the unpaid cost will somehow be passed on to other hospital patients…that means you and me.

Ok, so non-emergency care is cheaper than emergency care. So why doesn’t everyone use the doctor’s office or clinic instead of going to the emergency room?  What if you can’t, as most homeless people can’t, afford that non-emergency care?  The safety net in place is a Federally Qualified Health Center or FQHC.

What is a FQHC? A FQHC serves as the medical home and family physician to 15 million people nationally. FQHC patients are among the nation’s most vulnerable populations with about half living in economically depressed inner city communities. Nearly 70% of FQHC patients have family incomes at or below poverty. Nationally, 40% of FQHC patients are uninsured and another 36% depend on Medicaid, much higher than the national rates of 12% and 15% for the nation’s population as a whole. Two-thirds of health center patients are members of racial and ethnic minorities.

Where are the FQHC’s for the majority of this area’s homeless population?

According to the U.S. Department of Health and Human Resources Health Resources and Service Administration, Birmingham Health Care is the FQHC for this area. But remember, the study published recently said that it has been increasingly difficult over the past few years for the homeless to access health care at Birmingham Health Care. If it is difficult for the homeless people to access health care at Birmingham Health Care and at Cooper Green, doesn’t it stand to reason that these sick people will probably end up in an emergency room? If asthma is not controlled with routine medications, permanently damaged lungs and frequent hospital visits can result. If high blood pressure is not controlled, congestive heart failure can be the expensive consequence. If an abscessed tooth is not removed, bacterial endocarditis (a heart infection) can happen. Let’s not even go into the myriad of problems that result from uncontrolled diabetes.

To add another layer to this complex problem, homeless people have more medical problems than housed people. Really?

Yes, really, according to the above studies and articles. It makes sense that the common cold is easier to treat in your own home, on your own couch, with your own chicken soup, than if you are under the interstate, on your own concrete, with nothing to eat.  It only stands to reason that asthma is easier to treat if you have your own home, with your own inhalers and an ability to close the windows to the dust and pollen, than if you are on the streets, with no medications, and no doors, windows or walls to close to anything. If homeless people have more medical problems than housed people, they will need more medical care (or we could just house them, but that is a whole other story).

Back to the headlines…reduced access to medical care for our homeless population. Let’s believe that people with understanding of medicine, poverty, business, and the intersection of the three will step up and figure out how to wisely use the resources of our community to provide the care that area citizens deserve…whether that care is seen as a moral obligation or a financial imperative.

For more information about area homelessness, please feel free to review previous articles on our blog or take a look at our Point in Time information.

 Michelle Farley, Executive Director
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