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New mobile clinic supports medically underserved youth

Stanford's Teen Health Van aims to meet adolescents where they are

Benerelda Garcia, an 18-year-old senior at East Palo Alto Academy, struggles with depression and anxiety.

And when her mother lost her job earlier this year and Garcia became the sole provider for her family, working two jobs, she lost any access to health care – and could no longer afford the cost of the antidepressants she was taking.

Today, she's back on those medications and can regularly access free health care services in a large, bright blue RV-like van that travels throughout the Bay Area to provide such critical care to underserved adolescents.

The Teen Health Van, now in its 20th year of operation, is a mobile medical clinic that aims to reach medically undeserved youth, ages 10 to 25 years old, many of whom are homeless, uninsured or underinsured, at-risk and with little or no access to health care.

A new van that is replacing one that has been in operation since the program's creation in 1996 made its debut Tuesday at an official ribbon-cutting ceremony at East Palo Alto Academy, one of the primary sites the Teen Health Van visits to provide care for students like Garcia.

The van operates two days a week in Santa Clara, San Mateo and San Francisco counties. The Teen Health Van has regularly scheduled visits at Alta Vista High School, a continuation school that serves both Mountain View-Los Altos and Palo Alto Unified students; Los Altos High School; East Palo Alto Academy; and other locations in San Francisco and San Jose.

The van is staffed with a multidisciplinary team of health care professionals from Lucile Packard Children's Hospital: a physician who specializes in adolescent medicine, nurse practitioner, licensed social worker and registered dietitian/certified fitness instructor.

They provide comprehensive treatment ranging from immunizations, physicals and acute injury care to pregnancy tests, health education, substance abuse counseling and referral, mental health care and social services assessment and assistance, among other services.

Social workers also provide group classes on topics such as violence and dating, anxiety and relaxation, communication in relationships, eating disorders, body image and drug and alcohol education.

"Our purpose is to really be a safety net for those youth who otherwise do not have access to comprehensive primary health care services," said Seth Ammerman, a clinical professor of pediatrics-adolescent medicine at the Stanford University School of Medicine who created the Teen Health Van program in 1995.

Ammerman said 40 percent of the youth his team works with are currently or have been homeless in the past year. There are an estimated 1,500 homeless youth in Santa Clara County – about half of whom are in middle and high school – and 500 in San Mateo County, according to the Children's Health Fund, which partners with Lucile Packard Children's Hospital to run the Teen Health Van.

Ammerman said the van primarily serves three main groups of patients: low-income youth, primarily Latino, whose parents hold low-wage jobs with no benefits but make too much money to qualify for Medicaid; gay youth; and youth who have spent time in systems like shelters, group homes, foster care and juvenile hall, often receiving some medical care as minors but losing everything "overnight" once they turn 18.

The Teen Health Van also strives to provide more than just medical care. The team of physicians takes a "strength-based" approach with the young patients, focusing on their "inner strengths" to support them, Ammerman said.

In a video about the Teen Health Van showed at Tuesday's event, a former patient, a young woman in her late 20s, described how Ammerman and the van team provided her a much-needed "backbone" of not only medical but also emotional support.

"One of the things about all three of these groups of youth – a lot of adults have given up on them. 'Why bother? (I) can't do anything with them; they're troublemakers ... why waste resources and money?'" Ammerman said. "I'm here to tell you that is just absolutely not true. These are kids who, if you give them the help and support they need in a comprehensive manner, they can turn their lives around."

The new state-of-the-art van has two exam rooms, a small intake room and is equipped with technology from Samsung, a partner in the program, to further increase patients' access, particularly to specialists.

Samsung's "TeleHealth" technology allows physicians in the health van to video chat in real time with specialists who are miles away but can use tools like a digital stethoscope to diagnose Teen Health Van patients.

Patients who require specialty care, dental or vision services are provided a referral and often receive treatment at no cost, according to Lucile Packard.

Ammerman and other physicians also use Samsung tablets loaded with health information and interactive capabilities to pull up images on which they can draw or write notes to explain to a patient a condition or how a new medication works. Patients can also draw on the tablets to further explain their symptoms. The tablets are connected to large flat-screen monitors that hang on the walls of the van's exam rooms.

The new mobile clinic is the product of a partnership between the Children's Health Fund, Stanford Children's Health, Lucile Packard Children's Hospital and Samsung, which donated the technology for the van. The Bay Area van is almost entirely gift- and grant-funded.

Children's Health Fund, which is based in New York, partners with organizations and hospitals across the country to operate a fleet of about 50 mobile clinics in 25 different communities

Since its inception in 1996, the van has served more than 4,500 patients. The mobile clinic serves about 400 adolescents each year, with a return visit rate of more than 70 percent.

Amika Guillaume, principal of East Palo Alto Academy, opened Tuesday's event with sobering statistics about the high schools' student population, 95 percent of whom qualify for free and reduced lunch; 85 percent are second language learners and about half are considered homeless.

Without the Teen Health Van meeting these students' basic health needs, she said, "the idea of being ready to learn is not possible."

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