Victims of domestic violence benefit from dental program

victims of domestic violence

A groundbreaking initiative at a Queensland school of dentistry is empowering students to speak up about and help victims of domestic violence. By Andrew McMillen

During their schooling, dental students learn all about the oral cavity, and how to care for and repair damage that occurs over the course of a patient’s life. Cavities and decay may be influenced by factors such as poor diet, and these can be treated by skilled dentists. What students have traditionally not been taught, however, is how to recognise and respond to a patient who presents with injuries and damage incurred by domestic or family violence. Despite the unusually intimate role inhabited by dentists, many students report feeling unsure how to broach the question of whether they’ve experienced physical abuse from an intimate partner.

A nascent program at James Cook University (JCU) in Cairns is filling those gaps by equipping its Bachelor of Dental Surgery students with the tools to discuss these matters sensitively and skilfully with patients. The ‘Domestic Violence: recognise, respond and refer’ initiative at JCU has been in place for more than two years, and has seen about 240 students each year receiving specialist educational workshops that combine expertise in social work, dentistry and domestic violence prevention.

The need for such an initiative was identified by several students who were placed in regional, rural and remote sites including the Torres Strait, Northern Territory and Tasmania. “As part of that experience, the students were asked to write reflections around some of the challenges that they experienced,” says Dr Felicity Croker, a senior lecturer in dentistry at JCU. “In 2015, I had a number of students writing reflective pieces around their experiences with women who had experienced domestic violence, and how they felt out of their depth: they often felt like the places they were working weren’t really able to assist them to respond appropriately to these situations. It became evident to me that we needed some educational intervention.”

Dr Croker contacted her JCU colleague Dr Ann Carrington, a lecturer in social work, who then raised the idea of an additional collaboration. “I felt it was really important to bring in a local service,” says Dr Carrington. “Not only in terms of their continued work in that space, but I also think it’s important for the students to be able to see and meet the local services that they would potentially be referring to.”

Dr Carrington phoned Amanda Lee Ross, CEO of the Cairns Regional Domestic Violence Service, who has worked in this field for more than 15 years. “I’ve delivered a lot of training to other professionals that may come into contact with people experiencing domestic or family violence—such as doctors and nurses—but the one lot of people we’d never had any contact with was dentists. So, when I got that call, I was really excited about it, and very happy to be involved. It makes total sense: we see people experiencing facial injuries, and I’ve lost count of the number of clients who’ve lost teeth because of the violence.”

According to research published in the last two decades, up to 94 per cent of victims of domestic violence in emergency rooms presented with head, neck and facial injuries, which suggests that dentists are among the most qualified to assess and address the damage done. Yet as the 2015 JCU dentistry cohort identified, they needed to be taught how to raise this sensitive matter with their patients.

“Wherever I practise, I’ll make sure I’m aware of local domestic violence services, and things I can potentially refer people to. I do feel a lot more competent.”—Casey Townsend, dental student, JCU

After initially preparing a small workshop for the students who reported their concerns in their written reflections, Dr Carrington, Dr Croker and Ross then evaluated the students’ responses, and took to heart their comments that earlier education around recognising and responding appropriately would better equip them ahead of their clinical practice, which begins in their third year of study.

Today, the ‘Domestic Violence: recognise, respond and refer’ initiative is introduced to third year JCU Bachelor of Dental Surgery students via a two-hour session that covers taking a patient’s history, and some broader teaching around the prevalence of domestic and family violence. In their fourth year, the students do role-plays and are taught about non-verbal cues—such as not sitting behind a patient, or standing over them in the chair—that can help to ease anxieties, and facilitate honest conversations. In their fifth year, students bring back their experiences from clinical practice and reflect in small groups.

Although the initiative involves only a handful of hours across three years, JCU dental students have reported significant increases in their knowledge and confidence around this tricky matter. “I feel a lot better prepared,” says Casey Townsend, a 22-year-old JCU student, who also completed a research project on this subject with two male colleagues, William Shield and Winson Chan. “Wherever I practise, I’ll make sure I’m aware of local domestic violence services, and things I can potentially refer people to. I do feel a lot more competent.”

“I wouldn’t consider myself to be confident in approaching the topic, but with all things comes practice,” adds Chan, who is 22. “If I get some hands-on experience, and more preparation for it, I would be more inclined to talk to the patient about it. It’s the same as doing a filling: the first time, it was quite daunting, then after a couple of times, it became normal.”

While Dr Felicity Croker is far too modest to claim credit for sensing the opportunity to develop a groundbreaking educational initiative, her students are more than happy to heap praise on the senior lecturer. “She really cares about what she does,” says Townsend of Dr Croker. “Her passion is also making a difference, and making sure that we’re graduating as socially conscious health professionals. One of the things with our degree is that we really want to make sure we’re looking at the person as a whole. She’s good at instigating initiatives to help us learn about being aware of people and health as a whole—not just the teeth, not just the mouth.”

Above all, the JCU initiative empowers students to recognise the signs and consider making referrals where appropriate. “We’re not expecting them to be counsellors; that’s not their role,” says Amanda Lee Ross. “It’s about people being comfortable to call it when they see it—but also to do that in the right way. Most people don’t like going to the dentist, but this cohort of people may be anxious for a whole other reason, and that’s to do with what they’ve experienced at the hands of somebody else. I’m really excited by such a program as this: it’s exciting, it’s different and we are leading the way.”

For help with domestic or family violence concerns, please call 1800 RESPECT (1800 737 732) or visit ourwatch.org.au.

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