Students at the Harvard School of Dental Medicine (HSDM) are providing care to patients incarcerated at Suffolk County’s Nashua Street Jail in Boston. The students operate a weekly clinic at the 650-bed men’s facility as part of the Crimson Care Collective (CCC), a team of medical, dental, and mental health professionals from Harvard and other institutions.
“The waitlist for dental care is constantly overwhelmed, and many patients must wait in order to receive palliative treatment for highly progressed dental disease that can cause pain, sleep loss, or difficulty eating,” said Mindy Truong, DMD 2019, director of education for CCC at the jail.
Jails such as Nashua Street offer limited short-term palliative dental care. The Suffolk County Sherriff’s Department welcomed the partnership with CCC to provide expanded healthcare options to inmates, along with the opportunity to train future healthcare providers in a correctional setting.
“To our knowledge, this is the first collaboration of its kind involving student-delivered medical, dental, and mental healthcare in the correctional setting,” said Lisa Simon, DMD14, PD15, attending dentist for CCC. “This benefits patients, who have expanded access to care, dental students, who learn about the unique correctional setting, and medical trainees, who can learn more about oral health.”
Led by Simon, the collaboration began in October 2015 and has become a popular volunteer opportunity for DMD students. A student leadership board and faculty mentors run the clinic. Before entering the correctional setting, all volunteers attend mandatory training sessions, receive an overview of the justice system, and are screened for security clearance.
Students’ roles range from conducting patient interviews and providing educational programs to assisting in or performing clinical treatment. To date, more than 15 DMD students have participated in the program, and several alumni plan to work in a correctional setting or with formerly incarcerated people in the future.
“I honestly wasn’t entirely sure what to expect when I signed up to volunteer at Nashua Street Jail. This is my first experience working with a population in a correctional setting,” said Truong. “I’m constantly reminded of the importance of considering the patient as an individual human being with unique experiences and perspectives, while remembering that we are all linked by a common humanity.”
Working with the incarcerated population, students gain awareness of the complex social determinants of health. They also work closely within interdisciplinary teams to collaborate on patient care and overall health.
“People in jail face various health disparities that predispose them to increased morbidity and mortality. Many of our dental patients have complex medical conditions and/or mental health issues,” said Zhen Shen, DMS 2019, a dental integrated clinician with CCC.
“I’ve learned how to better communicate with incarcerated patients and address their special needs in addition to providing dental care. It is truly gratifying to see that our dental team at the jail values oral health as part of overall health, providing patients with interprofessional care,” said Shen.
The jail setting poses unique challenges, as patients may only be present for a short time while awaiting trial or sentencing, making it difficult to settle into a dental home. Dental students and faculty often make appointments or connect patients to community-based programs that will provide a transition to care when inmates are released.
Many students speak with compassion about the incarcerated patients they have come to know personally. Shen recalled a patient in his forties who came in with severe tooth pain and was diagnosed with irreversible pulpitis with an abscess.
“During our visit, he shared with us how saddened he was to miss his daughter’s birthday and hopes he could be in her life soon. His emotions were tangible,” said Shen. “Many patients like him, as much as they need their acute problem resolved, are also in a vulnerable position emotionally.”
“I would advise anyone considering alternative practice settings not to rule out the correctional setting based on any preconceived idea of what the interactions with incarcerated patients may be like. I truly have had only positive experiences,” said Lindsay D’Amato, DMD 2018. “I have developed a sincere interest in working in this type of setting in the future.”
Simon and her colleagues wrote about the model and their experiences in an article, “Dental Student-Delivered Care at a Student-Faculty Collaborative Clinic in a Correctional Facility,” for the American Journal of Public Health.
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