Dr. Seth Ammerman discusses what he’s seen in mobile health over 20 years, how it has impacted youth in the Bay Area and where the need still lies.
Q & A with Seth Ammerman, MD, medical director of the Teen Health Van and a clinical professor in the Division of Adolescent Medicine, Department of Pediatrics, Stanford University and Lucile Packard Children’s Hospital Stanford
The Teen Health Van started seeing patients 20 years ago. Can you tell us about its early days?
We started in 1995, and we were one of the first pediatric mobile health clinics in the country. In the beginning, we offered health care for children of all ages just one day a week in East Palo Alto, but it quickly became clear that we needed to have a separate day for adolescents. They were the least-served group in the county and had the worst health care outcomes. We discovered it wasn’t helpful to see teens on the same day as babies and young children, so we put in place an additional day just for adolescents. In time, the establishment of a permanent clinic took care of all the younger pediatric patients, which allowed us to operate the mobile clinic just for adolescents. It now visits eight sites in San Mateo, Santa Clara and San Francisco counties, and our services are free for patients and funded almost entirely by donors. It caught on far more quickly than I had anticipated.
Whom do you work with?
Our focus has always been on uninsured kids. We are a safety net program. Forty percent of our kids are currently homeless or have been homeless within the last year. We also work with at-risk and high-risk youth. A lot of the kids we see have parents in low-earning jobs and, even with the Affordable-Care Act, they can’t afford to pay health care premiums. We also see LGBTQ youth and kids who have been in group homes, foster homes, shelters and/or juvenile hall. The highest percentage of kids we see are Latino, the second highest are Caucasian. Our patients range in age from 10 years old to 25, but the vast majority are ages 15 to 25.
How does your program measure success, and what’s the secret to continued success?
Since the program began, we’ve been able to serve more than 4,500 unique patients. Currently, we see about 400 patients annually — patients who would struggle finding care elsewhere. We take a comprehensive, strength-based approach. A lot of the kids we work with often hear from adults and society about what’s “wrong” with them and what they’ve done wrong. We focus on their strengths and not their weaknesses. We always ask them what they like best about themselves and what they are proud of. The kids really respond to it, and it makes a difference. A lot of this sounds very serious, and the problems they have are serious, but we really try to have fun with the kids and make them feel comfortable. With that approach, more than 70 percent of our patients come back and see us for continued care. The average length of time we see a kid is 2½ years, but some of our patients have been coming to us for as long as 6 years. We measure our success by looking at a variety of short-term, medium-term and long-term outcomes, such as increase in immunization rates; decrease in risky sexual activity; decrease in use of tobacco, alcohol and other drugs; and screening and treatment for depression.
Have the changes in the Bay Area affected the work you do?
Sometimes I feel like I’m working in a developing country because the kids we see don’t have the immunizations or medicine they need. We’ve always seen a lot of mental health issues, such as depression, psycho-social issues, obesity, malnutrition, and common adolescent problems like headaches, stomach aches, menstrual disorders, and birth control needs. The biggest change I’ve seen is that we’re treating more and more kids of the working poor. In my opinion, it’s a product of the region’s exorbitant cost of living. A lot of these families either can’t afford health insurance or they lost it. These are families who were never expecting to need a program like this. We could have two vans running every day of the week. Due to the economic disparities, there are just more people who are struggling financially. I get calls all the time from agencies asking if we can have the van come out, and unfortunately we already have a long waiting list.
What has changed?
We got a new mobile health care clinic last year. We were using the original retrofitted van from 1995, and it was about to fall apart, so the timing could not have been better. The new one is the same size, but the way it’s designed, it’s much roomier and more engaging inside. Thanks to the Children’s Health Fund, Samsung and other donors, it is equipped with telemedicine and telehealth technology that you normally would only see in an advanced medical center. It allows us to show the kids on a computer what we are looking at on their bodies. They love it.
What does the future hold for the van?
We continue to evolve our services and care model to best accommodate our patients’ needs. It would be great if we didn’t need a program like this, but given how things have been going with the economy and the kinds of social issues that are prevalent nationwide, it’s undeniable that the need for programs like this is growing. Apart from treating health issues and concerns, we have adapted the program to promote well care and have seen great results, like improved nutrition and physical activity in 60 percent of our patients. Cooking classes offered at various sites have resulted in teens planning meals and eating more regularly as well as mindfully. In addition, participants in our onsite fitness training programs report that they are doing more walking, dancing, biking and yoga.
When I invite people out to visit the program and they see that the kids we are serving look just like their kids and act like their kids, it’s really eye opening. I’m happy that mobile health care is a proven and recognized way to provide health care, particularly for adolescents. We all need to take care of each other if we are to ultimately succeed and provide our young people with the care they need and deserve.
The Teen Health Van program is possible thanks to the community’s support. You can help us serve at-risk youth by donating at http://my.supportlpch.org/teenvan.
Discover more about the Teen Health Van.
