Feeling at home

March 1, 2001
Jacksonville hygienist rolls out the welcome mat for the homeless as part of the city's effort to aid recovery from life on the streets.
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Dawn Vonderau believes her career as a dental hygienist is more spectacular than she ever had imagined. Two years ago, just after graduation, she went to work for the I.M. Sulzbacher Dental Center for the Homeless in Jacksonville, Fla. Vonderau has a profound sense of pride about her job, both personally and professionally. She sees the impact of the clinic's services in the oral health of her patients. In addition, her care can directly influence someone's recovery from homelessness.

"Once someone's oral health is restored, his self-confidence and self-esteem soars. This helps him to re-establish his life," Vonderau explains.

Vonderau's first experience at the dental center came while she was still in school during one of the scheduled clinical rotations. However, before her class toured the center, she had already formed a negative impression of it in her mind. She thought it would be overwhelming to render care to this underserved population.

"What could we (students) possibly do to make a difference?" she questioned herself silently.

But the tour immediately changed Vonderau's attitude and captured her heart. As it turned out, the clinic was quite different than expected. Although not very large, the new, three-operatory facility was immaculate. The clinic's director, Dr. Cindy Skigen, was very welcoming, as were the staff and patients.

Once clinic rotations began, so did the real challenges. The patients, some of whom had never had their teeth cleaned, had heavy calculus and stain. Vonderau quickly discovered that she loved this opportunity to "flex her skills." Not only was it possible to see dramatic visual results, Vonderau explains, but it was also necessary to provide more in-depth oral hygiene instructions.

During the rotation, Vonderau had no idea she would wind up working at the clinic after graduation. She still recalls how nervous she was during her actual interview with Dr. Skigen. Vonderau was hired for the position even before she received her board results, but it has been a perfect fit.

Vonderau's typical day is unlike that of her peers in private practice. Her average patient is either homeless and/or qualified as low income. The clinic also sees immigrant patients at a reduced fee. Vonderau's patients have had little to no dental care in their lives. Most patients have complex medical histories, are dental phobics, and are motivated by pain to visit the clinic.

The clinic's staff has a challenge not only to assist the patient by alleviating pain (most patients seek extractions), but they also strive to educate patients about the benefits of returning for additional dental care. Since many patients have had limited dental work, more times than not scaling and root planing are needed. Some immigrants have had extensive dental work completed in another country, but their home care is so poor that the work needs to be redone.

Across the country, the face of homelessness has changed. Vonderau's patients reflect our changing society. These new faces now include many women, children, and families who become homeless due to unfortunate or catastrophic circumstances. Homeless individuals often are grouped into four categories:

  • The situationally homeless who have been displaced by a job loss, death of a spouse or parent, or an abusive relationship
  • People with substance-abuse problems who are unable to maintain employment
  • The borderline homeless who have emotional or behavioral problems that have led to bad decisions
  • The chronically homeless who are extremely dysfunctional

The patient population seen at the dental center differs tremendously from that of private practice. The patients are very transient. Even when they reside at the Sulzbacher Center for the Homeless, it is only on a short-term basis until they get back on their feet. Many of the patients participate in a rehabilitation program either at the Sulzbacher Center or another local treatment facility.

This creates a challenge for Vonderau when it comes to confirming patient appointments. Often, it is not possible to reach patients directly. Due to confidentiality issues, the rehabilitation programs cannot disclose the identity of their clientele. As a result, she has very few recall patients, and it is virtually impossible to follow up with care once they leave the facility.

Vonderau realizes how important it is to maximize her appointment time with her patients, another difference from the typical private practice. She has become very skilled at putting her patients at ease by listening carefully to their fears and concerns. After gaining their trust and respect, she motivates them to want to improve their oral health.

Meeting a diversity of needs

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In addition to providing dental care, the Sulzbacher Center for the Homeless provides a number of other critical services for their guests, such as complete case management assistance and a number of health-care services. The case management services are intended to enable someone to recover from the problems that lead to homelessness. Within 48 hours of entering the shelter, guests must meet with a case manager to develop their individualized plan for recovery. The case manager coordinates various agency and community resources to best meet each person's needs, whether it is enrollment within a rehabilitation program for substance abuse or seeking assistance from one of the full-time on-site job placement specialists from Goodwill Industries.

The "Steps to Home" program teaches life skills that promote independent living, including checkbook maintenance, budgeting, parenting, and hygiene. These valuable skills enable participants to maintain their independence once they move from the shelter into stable housing.

In recognizing that more families suffer from homelessness, the Sulzbacher Center addresses the needs of homeless children. Approximately 30 to 50 children live in the family dormitory at any given time. The center employs a full-time children's team that includes a family case manager, a child development specialist, and a nurse case manager who provide educational, developmental, and social enrichment activities. Last year, the center also opened its own after-school program to further meet the needs of children who stay at the Sulzbacher Center.

During the last fiscal year, the on-site health care clinic had 14,631 patient contacts. All health care is furnished free of charge, except for a $10 charge for eyeglasses. Each guest receives a complete medical screening as part of the intake procedure. Medical services include primary health care, a vision clinic, pediatric and asthma care, HIV/AIDS testing, counseling and case management, and breast cancer screening.

The vision clinic conducted 319 eye exams in 1999. Twenty-nine optometrists hold weekly clinics, and a local optical company supplies glasses at $15 per pair. The health center furnishes basic medical services to children who do not have access to health care or are awaiting enrollment in Medicaid. Additionally, the center provides physicals for school-age children while they are in the homeless shelter. In 1994, the Community Asthma Project established an asthma clinic for the homeless and uninsured. This clinic operates on the first Saturday of each month and is staffed by volunteer physicians and health-care professionals.

The center also has a "Clinic Without Walls" program. The "Clinic Without Walls" is a comprehensive medical outreach program providing early intervention, prevention, and health-education services to the men who seek shelter in the Pavilion. The Pavilion is the component of the center that serves the most transient individuals. This unique approach has been very successful in breaking down the barriers for this population, encouraging access to health care.

Although the health-care clinic offers services to individuals with HIV/AIDS, it does not furnish the much needed specialty medical care or medications. Instead, the assistance helps these patients receive care through already existing community programs.

The Breast Cancer Program, funded by The Susan G. Komen Foundation, performs 300 breast examinations and 120 mammogram screenings annually. The mission of the Susan G. Komen Foundation is to provide breast health services to homeless and poverty-stricken women in the Northeast Florida area.

Every year - through the efforts of the staff, community partnerships, and volunteers - the Sulzbacher Center continues to experience remarkable results in assisting their guests to find stable employment and stable housing. In fiscal year 1999-2000, the center provided shelter and recovery services to 2,681 homeless men, women, and children. Approximately 538 homeless individuals successfully moved into their own homes, and 560 obtained stable employment during that year.

On occasion, Vonderau sees former patients after they have left the shelter. "It's very rewarding to know that I played a part in helping someone get back on his feet," Vonderau says.

She particularly recalls one middle-aged gentleman who not only had severe dental problems but had medical problems as well. He had 5-6 mm pockets with heavy calculus and stain from smoking cigars. While he was receiving medical and dental care, he was also enrolled in the job place-ment program. Vonderau attributes the fact that he is now gainfully employed to the integrated services that the center provides.

During the past two years, Vonderau's role has grown from part-time hygiene duties into a full-time position. Her position now includes administrative duties such as managing the business office, coordinating the dental volunteers and dental advisory committee, and serving as a community liaison.

Vonderau views her career in a very broad perspective, as she believes that she is contributing to the cure for homelessness, one patient at a time. For more information about the I. M. Sulzbacher Center, please visit their Web site at www.imshomelesscenter.org.

Linda Harvey, RDH, MS, is a risk manager and consultant in Jacksonville, Fla. She may be contacted for more information or professional coaching via e-mail at harvey@ mediaone.net or (904) 573-2232.

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Long before Vonderau ever thought about becoming a hygienist, key individuals within the community began to set a plan into motion that would pave the way for her career. This monumental plan addressed homelessness within Jacksonville. During the late 1980s and early 1990s, a growing number of street people began to cluster in the downtown area. One survey conducted by the Emergency Services and Homeless Coalition (ESHC) determined that there were more than 2,000 homeless individuals in the community. - IMG SRC="icons/ogj/2103rdhhmlb.e">

In response to this growing problem, a city ordinance was proposed that prohibited vagrancy, including a ban on sleeping and bathing in public. Violation of the ordinance could result in a $500 fine and 90 days in jail. Realizing that no alternative existed for these individuals except going to jail, community leaders rallied to establish a 24-hour homeless shelter. City officials concurred with this solution and worked closely with community leaders such as Mr. I. M. Sulzbacher to solve the problem.

A location for the homeless center was found and approved by the city council in September 1993. It was announced that the new facility would be named the I. M. Sulzbacher Center for the Homeless after the former city councilman and past chairman of the ESHC. The center opened its doors in December 1995 to fulfill a community need to care for the homeless.

The Sulzbacher Dental Center for the Homeless opened in January 1997. Funding was made available through a grant from the Robert Wood Johnson Foundation. The grant made it possible to target homeless individuals who lived below the federal poverty level. A 1996 survey of the homeless population in Jacksonville demonstrated the need for this one-of-a-kind facility. The results showed that 76 percent of this population did not receive dental care, and 68 percent had existing emergency dental needs.

In addition to receiving the grant, a number of community organizations and volunteers help make this dream a reality. The local public health department, dental and dental hygiene volunteers, and the Salvation Army are just a few of the special individuals who donate their time and talents. In addition, Sullivan Dental donated about $40,000 in new dental equipment.

While the dental center does provide a full array of dental services, some minimal fees are charged. For those patients who are residing at the Sulzbacher Center for the Homeless, a dental visit costs $10. The immigrant patients and those who qualify as "low income" pay $25 per visit. Recognizing that more times than not something received for free is not valued, the fees are intended to offset any lab costs as well as encourage patients to be responsible about keeping their appointments and valuing the care they receive. In 1999, 2,212 patients visited the dental center.