Publication Date

Spring 5-29-2024

Item Type


Executive Summary

Coming Alongside Women Experiencing Homelessness

Executive Summary

Six nursing students attending Seattle Pacific University (SPU), partnered with a women’s day center to provide and support healthcare needs for a leadership project. During the first few weeks of being at the shelter, we visited the agency site to get a better understanding of the population and have a greater idea of what the focus problems should be. Our assessments consisted of a windshield survey, in-person observations, and conversations with the shelter director, staff, and women to identify barriers within their healthcare services. We further gathered assessment information from our instructor, who previously collaborated with the shelter. This information highlighted issues such as underutilization of health resources due to avoidant behavior, stemming from negative past experiences in medical settings. Additionally, impaired social interaction and self-affirming behaviors were noted, linked to the COVID outbreak, as evidenced by staff reports, observations, and refusals to participate in affirmation activities. By formatting the visits into weekly activities the women could participate in, such as coloring, drawing, painting, and making cards with affirmations, we were able to build rapport, and trust, and create a sense of empowerment for the women to bridge the gap between healthcare and the homeless population. We aimed to foster engaging activities for the women, aiming to alleviate mistrust stemming from past negative experiences. Additionally, we embraced the opportunity for the women to benefit from a mobile dental van acquired by former SPU students.


The day and overnight shelter is a place for homeless women to find sanctuary, providing limited supplies such as overnight beds, meals, and support services for approximately 80 women who are experiencing homelessness or are seeking a safe place from domestic abuse. While it offers drop-in services for the women, there is still a gap between the oral care practices the women receive. Research shows that individuals “with a longer length of lifetime homelessness, those who were smokers and misused drugs and alcohol had dental problems more frequently” (Mehia-Lancheros, et. al, 2020). According to the National Library of Medicine, dental care is ranked as one of the leading unmet needs among the homeless population, and despite oral health needs, there is poor access to dental care and a three times greater prevalence of oral pain than that of the general population (Freitas, et. al, 2018).

A previous SPU nursing leadership group created a pathway for the women to obtain dental care by funding a mobile dental van to come on-site at the women’s day center. The dental van grant was approved and provided the leadership group with enough funds for three visits over 19 months, about once every six months. Due to this being the dental van’s first visit to the women’s center, we aimed to foster participation by organizing engaged activities to build trust and encourage involvement.

Weekly Activities

Our assessments depicted a lack of socialization, self-affirming behavior, and a decline in mental well-being after a recent winter COVID-19 outbreak at the facility. Frontiers of Psychology research shows connections between mental health decline and the COVID-19 pandemic (Clemente-Suárez et al., 2020). To help combat these lasting effects of the outbreak we created weekly social activities consisting of music therapy, art, and affirmations every week after our assessment phase. A systematic review showed a statistically significant reduction in stress and anxiety with music therapy (De Witte et al., 2020). We used art to provide self-affirmations. The residents were instructed to write positive words to themselves or others at the facility. These words were then posted on the walls as a consistent reminder. “Self-affirmation is a strategy to bolster and appraise the self as competent, good, coherent, unitary, stable, capable of free choice, capable of controlling important outcomes.” (Albalooshi et al., 2019). With this population, it is common to see disempowerment and a lack of confidence in oneself. Self-affirmation and art were our ways of giving appraisal and facilitating positive thoughts.

Weekly Activity Outcomes

After implementing the activities each week the group evaluated what worked well about them and what could have been done better. Observations of the women at the site proved that the activities were successful, each week there were between 10-15 participants in the art, music, and movement therapy sessions. Reports from the women showed that they enjoyed our interventions and felt more comfortable with going into the dental van.

Dental Van Usage

Flyers about the dental van were made in English, Spanish, and French, ensuring clear communication. For the dental van day itself, we created a waiting space that provided drinks, flowers, and a speaker to play relaxing music, fostering a welcoming atmosphere. In line with a systematic review by Paisi (2018), we prioritized flexibility and tailored services by bringing the van directly to the site, accommodating the chaotic lifestyles of homeless individuals, and promoting accessibility to dental care. To foster a comforting environment, conversations with the women were encouraged. An admit sheet for the women with appointments was made to write down their names, date of birth, allergies, current medications, and their priority dental issues. Combining these efforts provided a supportive environment for the women receiving dental care.

Dental Van Outcomes

The interventions we put in place before the dental van arrived helped substantially. The women at the shelter acknowledged their need for dental care assistance but could not seek services due to safety concerns, previous negative experiences, and financial inabilities. One outcome was to obtain 8 women to sign up with 2 women on standby if any of the scheduled appointments had cancellations. We were able to obtain over 10 sign-ups with 2 women on standby, with a total of 8 women participating. The second outcome was to build trust with the women through activities each week, which was met as the number of women who participated increased each week with many expressing their gratitude. The third outcome was to provide feedback through emails to the site manager and the dental van coordinator about what went well with the van and what could be improved for future visits. This outcome was met as we provided insight into what we observed that day. These emails will help the site manager, the dental van coordinator, and future nursing students better understand what to provide the women before and during the day of the dental van and what resources could be continued or further utilized.


We successfully partnered with a women’s day center to support the healthcare needs of women experiencing homelessness. We achieved our goals of building trust and providing access to dental care through the mobile dental van. The weekly participation of ten to fifteen women displayed the success of our efforts to engage with the women in activities to foster a sense of community and empowerment. By promoting the dental van in advance through conversations and clear, multilingual flyers, we ensured the women were well-informed and comfortable with receiving dental care.

In the future, projects could improve dental van visits by building on our established framework, and ensuring coordination among the dental van staff, women's day center staff members, and the nursing students. Additionally, they should ensure a therapeutic approach is planned and implemented beforehand.


Albalooshi, S., Moeini-Jazani, M., Fennis, B. M., & Warlop, L. (2019). Reinstating the resourceful self: When and how self-affirmations improve executive performance of the powerless. Personality & Social Psychology Bulletin, 46(2), 189–203.

Clemente-Suárez, V. J., Dalamitros, A. A., Beltran-Velasco, A. I., Mielgo-Ayuso, J., & Tornero-Aguilera, J. F. (2020). Social and psychophysiological consequences of the COVID-19 Pandemic: An extensive literature review. Frontiers in Psychology, 11.

De Witte, M., Da Silva Pinho, A., Stams, G., Moonen, X., Bos, A. E., & Van Hooren, S. (2020). Music therapy for stress reduction: A systematic review and meta-analysis. Health Psychology Review, 16(1), 134–159.

Freitas, D. J., Kaplan, L. M., Tieu, L., et al. Oral health and access to dental care among older homeless adults: Results from the hope home study. Journal of Public Health Dentistry, 79(1), 3-9.

Mejia-Lancheros, C., Lachaud, J., Nisenbaum, R. et al. Dental problems and chronic diseases in mentally ill homeless adults: A cross-sectional study. BMC Public Health, 20(419).

Paisi, M., Kay, E., Plessas, A., Burns, L., Quinn, C., Brennan, N., & White, S. (2019). Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review. Community Dentistry and Oral Epidemiology, 47(2), 103–111.

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