Health on Wheels
Published on in Children's View
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Published on in Children's View
By Zan Hale
When Children’s Hospital of Philadelphia’s new RV-sized clinic on wheels meets youth where they are to provide health services, it’s not just about location.
Of course, the beauty of the Mobile Health Unit (MHU) is that it can go to any neighborhood and within minutes be a fully operational clinic, complete with an exam room, consultation/testing area and lounge space.
But just as importantly, the MHU also meets youth and young adults where they are medically, emotionally and sexually.
The Adolescent Initiative (AI) has been reaching out to underserved youth ages 13 to 24 for more than 27 years with a focus on preventing HIV and other sexually transmitted diseases. But until recently, the services the AI outreach team members could offer were often limited, depending on where they went. At recreation centers all over the city, for instance, they would set up in closets or offices, stringing tarps to give the youth privacy. At night clubs, they might have taken over the not-in-use kitchen. At health fairs, they would be restricted to setting up a table, distributing information and encouraging interested teens to come to an Adolescent Medicine clinic.
“Sometimes, all we had was what we could carry in a backpack,” says Marne Castillo, PhD, MEd, AI’s Research and Clinical Director.
About five years ago, though, Castillo saw a video of a large RV outfitted as a mobile health unit, bringing medical care to at-risk people in South Africa. “Right then I told the team, ‘We need one,’” she says.
The AI team applied for a Chair’s Initiative grant, CHOP’s internal funding program for inventive new projects, and the MHU was selected in 2019 to receive two years of support.
“I think this is the most innovative project we have supported in the 15 years of the Chair’s Initiatives,” says Joseph St. Geme, MD, Physician-in- Chief, Chair of the Department of Pediatrics and holder of the Leonard and Madlyn Abramson Endowed Chair in Pediatrics. “It’s such a creative solution to addressing the needs of a critically important population in our community. The ability to bring services directly to youth — health education, testing, support, access to insurance — is really compelling.”
After purchasing the 30-foot-long RV that would become the Mobile Health Unit, the AI team worked with its Youth Community Advisory Board (YCAB) to ensure the interior and exterior would attract youth and put them at ease. “From the start, our YCAB members’ input was critical,” Castillo says. “They’re the experts on what will draw in their peers.”
The AI team, in partnership with CHOP’s Marketing Department, reached out to several well-known Philadelphia artists and asked them to submit potential designs for the MHU’s exterior. The YCAB reviewed the entries and selected the work of Alloyius Mcilwaine, who has painted bold, colorful murals all over the city. Throughout the design process, the YCAB offered feedback and ideas for landmarks and words to be incorporated.
“Wow!” says YCAB member Kyla Outen, 21, of how the MHU turned out. “I love the unconventional way it shows Philly. It’s more than our history. Alloyius incorporated our message that all individuals matter and all deserve to be healthy, not only physically, but emotionally and mentally, too.”
For YCAB member Dionte Gill, 22, the final design “hit the mark. It’s pop art and will definitely draw attention,” he says. “My favorite part of the process was seeing the initial designs and then seeing how Alloyius took our feedback and changed it so it’s truly our vision.”
It takes more than a beautiful exterior to draw youth to the MHU unit, though. Gaining trust is integral to the unit’s success.
“The first tier is all about relationship-building,” Castillo says. “The second tier is delivery of services. We’ve got to establish the safe space before young people feel comfortable to say, ‘OK, I’m going into this RV and getting an STI test.’”
To help engage youth, the MHU has a great sound system, a TV, phone chargers, public Wi-Fi and comfortable chairs. When it pulls into a park, for example, the awning expands, music plays, a PS5 gaming system is set up, and snacks are set out. The MHU also carries condoms and hygiene supplies, as well as donated gift cards to help youth who are homeless or in need of a meal.
“We want it to be a spot for people to come and chat, to have a safe space to hang out for a while,” Castillo says. “Kids can have some fun while they get information.”
Once conversations start, staff present what’s available in the MHU: point-of-care rapid HIV or STI testing, basic health screening, risk assessments, screening to participate in research studies, educational videos and learning games on health topics. “They can tell us about their barriers to receiving healthcare, and we can help remove what gets in their way,” Castillo says.
For LGBTQ youth, the MHU can play a particularly important role. It offers a safe space to provide education for young gay men on pre-exposure prophylaxis (PrEP, medication that reduces the spread of HIV), for instance, and to share information on CHOP’s Gender and Sexuality Development Program. The MHU can also be temporarily turned into a clothes closet so transgender youth can select outfits that match their gender identity.
“We can ask sensitive questions while we keep their identity in mind,” says Matty Lehman, MSS, a social worker and program coordinator for AI. “Sometimes, kids aren’t comfortable with the level of disclosure they think will happen at their own doctor or if their family is with them. Others don’t engage with the medical system, or they distrust it. With the MHU, they can engage on their terms, in their community.”
The MHU also has secure access to CHOP’s scheduling system to make appointments with Adolescent Health specialists right then and there. The team can also help youth see what health insurance they’re eligible for or connect them with federally funded clinics that offer free services.
The possibilities for the MHU are vast. For example, one goal is to have consistent monthly MHU visits in underserved neighborhoods, so youth will know when it will be nearby. “That’s important from a health equity standpoint,” Castillo says. Additionally, with more support the AI team can arrange to regularly frequent neighborhoods with rising rates of HIV and STIs to provide services.
Various CHOP programs would be great collaborators — whether to improve asthma management, share resources from the Center for Violence Prevention, or address food insecurity in coordination with CHOP’s initiative to tackle the socioeconomic and environmental factors that negatively affect children’s health.
However, the MHU’s reach is currently constrained by staff and resourcing limits. “It’s a labor of love now,” says Castillo.
To learn more about how you can support the Mobile Health Unit and the Adolescent Initiative, contact Matthew Sware at 267-426-7030 or SwareM@chop.edu.