Teen Van takes medical care on the road

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Some 1.4 million students in public schools are homeless. With that often means no health insurance or access to a doctor's office.

That's not stopping one San Francisco Bay Area hospital from providing care.

If the kids won't or can't go to the doctor's office, they'll bring the care to them – for free.

There is a new face of the uninsured and homeless: kids. Almost 40% without a home are under the age of 18. And that leads to a new problem when it comes to health care.

"You would think that in our country, all of our teens would have health care. But as time goes on, we're actually seeing that the needs are increasing," registered nurse Lisa Lestishock said.

That's where the Big Blue Bus comes in, better known as the Teen Van. For more than 20 years, this doctor's office on wheels has provided care to those between 10 and 25.

With support from Lucile Packard Children's Hospital Stanford, all care and medicine are free.

"I was really surprised that it was free," Erika Roland Fernandez said.

That allows the Teen Van to focus on those in need.

"We can be out in the community meeting kids where they are," Teen Van interim medical director Dr. Megen Vo said.

"One of the students I've been working with, he is 18 years old. He is currently homeless," social worker Nathalie Servin said.

"Forty percent of our patients either are homeless or have been homeless," Vo said.

The van has treated more than 4,500 patients since it started. On board are a doctor, nurse, nutritionist and social worker to address the various needs of the patients.

"Every kid that comes to the van gets a pretty comprehensive assessment," Lestishock said.

With a return rate of 70%, the team is able to develop a level of trust with patients.

"Sometimes many teenagers do feel alone. With the social worker, I was able to talk to her about personal problems," Roland Fernandez said.

And that makes all the difference for the Teen Van's young patients.

The teen van provides care at schools and community centers within the San Francisco Bay Area.

Several other programs caring for the underserved are offered in cities across the country. For instance, New York City's Center for Urban Community Services Health Van is devoted solely to helping those living on the streets.

RESEARCH SUMMARY
TEEN VAN TAKES MEDICAL CARE ON THE ROAD
REPORT #2691

BACKGROUND: At the beginning of the 2016-17 school year, there were 1.4 million students who were considered homeless. Of that number, male and female children in shelters were roughly equal. This is more than twice the number of students who were homeless in the 2004-05 school year (590,000). The majority (75 percent) of students experiencing homelessness were "doubling up" with other families. One-sixth (15 percent) were staying in shelters, 7 percent were in hotels or motels, and 4 percent were "unsheltered," meaning that they were living outside in abandoned buildings, cars, or other places not meant for human habitation. Children in federally funded shelters are disproportionately young; 10 percent of all children experiencing homelessness who spent time in shelters were under the age of 1, 35 percent ages 1 to 5, 34 percent ages 6 to 12, and 22 percent ages 13 to 17. Among unaccompanied youth (that is, youth unaccompanied by an adult), a large majority (87 percent) were ages 13 to 17. (Source: https://www.childtrends.org/indicators/homeless-children-and-youth)

MOBILE CLINICS SERVING HOMELESS YOUTH: Twice a week, Seth Ammerman, MD, a clinical professor of adolescent medicine at Stanford University, and two nurses park the mobile clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung. The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population. "Going to the patients makes all the difference, and it's not just a matter of convenience," says Ammerman, "It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them." (Source: https://www.kqed.org/stateofhealth/146345/as-homeless-youth-population-grows-mobile-clinics-are-key-resource)

WHAT HOMELESSNESS REALLY LOOKS LIKE: To teach future doctors, nurses and pharmacists how they can advocate for systemic changes, for better housing policy, or against de facto incarceration of the mentally ill, and how to improve their interactions with individual patients, UC San Francisco provides an elective course each fall that brings in experts to lecture on the subject. "My experience with the course helped me understand what homelessness really looks like and has taken away a lot of the stigma and generalizations about people who are homeless," said Megan Byers, RN, who took the Homeless Health Issues elective and is now one of the student coordinators. The student-run course brings in subject experts to speak about the structural and policy issues that contribute to homelessness and the specific needs of the population. After nearly three decades, many alumni of the Homeless Health Issues elective have become clinicians, researchers, and faculty dedicated to helping underserved populations. (Source: https://www.ucsf.edu/news/2018/09/411871/address-homelessness-effectively-clinicians-are-learning-what-it-really-looks)