Identifying Needs of Practitioners Caring for Children in Out-of-Home Care

Objectives: Children in out-of-home care (OOHC) face greater oral health challenges than their peers due to factors such as residential instability, low prioritisation of oral health, and behavioural challenges linked to adverse childhood experiences (ACEs). However, the experiences of oral health practitioners (OHPs) in managing their care remain underexplored. This study examined the perceptions and practices of Australian OHPs providing care to OOHC children, focusing on their knowledge, confidence, barriers to care, and recommendations for improving care.
Methods: A qualitative exploratory approach was chosen, with purposive, snowball, and convenience sampling used to recruit 19 OHPs for semi-structured interviews. Participants were primarily general dentists aged 25–34 with less than 10 years' experience, practising in metropolitan areas across public and private sectors. Interviews were conducted via Zoom, transcribed, and analysed using a hybrid (inductive and deductive) thematic approach. A coding framework was developed and refined through author consensus to ensure rigor.
Results: Many practitioners recognised the impact of OOHC and ACEs on oral health (n=11). Most OHPs reported positive experiences with carers (n=10), noting opportunities to support children and carers beyond clinical roles. Some OHPs (n=6) perceived private OHPs as less knowledgeable, experienced and willing to manage OOHC children, compared to their public sector peers. Barriers to care included behavioural challenges, high carer and caseworker turnover, inadequate record-sharing and unclear consent processes. Although some OHPs used supportive strategies, most (n=13) felt inadequately trained to manage OOHC children and navigate systemic barriers. Participants called for improved training, specialised recall systems and streamlined administrative support.
Conclusions: The perception that private OHPs are less equipped to manage these children raises concerns about equitable care access for this vulnerable group. Australian OHPs require improved training, clearer guidelines and administrative support to navigate systemic challenges and enhance care for children in OOHC.