A Day in the Life of a Mobile Health Clinic

Harvard Square in Boston, Massachusetts, is a renowned tourist area, known around the world for its shopping, dining, entertainment venues, bookstores, architectural landmarks, and cultural destinations. It is also a place where a large number of runaway and homeless youth sleep every night—some suffering from medical illnesses, others just hungry and alone.

A mobile health clinic run by Bridge Over Troubled Waters, a FYSB grantee in Boston, Massachusetts, parks in front of Harvard Square every night for one hour, from 8:30 to 9:30 p.m.

The van runs from 6 p.m. to 10 p.m.—the hours that they can reach the most homeless teens—and stops at shelters, parks, and subway stops. The street outreach team accompanies the van, passing out sandwiches on Tuesdays along with “survival guides”—brochures that highlight food banks, transitional living programs, and shelters that serve homeless youth.

For some street youth, the majority of whom are uninsured and ineligible for Medicaid, this is the only health care that they will receive. Many young people on the streets do not have money for public transportation to get to a local hospital or clinic. The mobile health clinics meet the needs of runaway and homeless youth by bringing the services to them.

“We have an open access policy,” says Dr. Rhonique Shields-Harris, medical director of the mobile health programs at the Children’s Health Project in Washington, D.C. “You come in, we don’t ask questions. We would rather they use us as a resource than go to the emergency room, where the wait time will be longer.”

This policy appeals to street youth who are often wary of going to hospitals or clinics for fear of being turned in to police or social services.

“People are more trusting of the medical van,” says Peter Ducharme who runs the medical van for Bridge Over Troubled Waters. He adds that many homeless youth have escaped abusive situations and are scared of being returned to their homes.

When street youth are looking for additional support, however, the mobile health clinic can refer them to drop-in, basic center, and transitional living programs. Mobile clinics address the needs of runaway and homeless youth, who have a high risk of getting infectious diseases from being out on the street.

Many youth from Covenant House—a FYSB grantee and runaway and homeless youth program located onsite with the Children’s Health Project—come to the agency because they are referred by doctors with the mobile health clinic. For example, when a pregnancy test reveals that a young woman is expecting, a mobile health clinic will often refer her to a transitional living program.

In fact, Bridge Over Troubled Waters began in 1970 as a mobile health clinic and grew into a human service organization which includes a street outreach program, a transitional living program, and residential housing. Of the 4,000 youth the agency comes in contact with each year, 2,000 are seen on the medical van and 2,000 are serviced by onsite facilities. About 1,300 are referrals from street outreach workers.

“We run into a lot of people who will come to the van and ask questions, and it might not be an absolute emergency or a crisis, but we will get them answered at the van, rather than risk going to a hospital,” says Ducharme. When youth go to the hospital, he says, the van program misses the opportunity to refer youth to additional services like drop-in programs.

Treating the Whole Person

It’s a clear morning and two large blue vans—a mobile health clinic and a mobile dental clinic—pull away from the Children’s Health Project on Mississippi Avenue in Southeast Washington, D.C.

The vans rumble along turning down streets in the Parkland neighborhood before arriving at the Atlantic Terrace Apartments, alow-income housing project where they will park for the day.

Inside the mobile clinic at the Children’s Health Project, Dr. Terry Gray Brown sits in a swivel chair waiting for her next patient. She comes out from time to time, maneuvering her 8-month pregnant belly past her colleagues and patients in the narrow 2-foot hallway. She works in the mobile clinic 5 days a week, from 10 a.m. to 4 p.m. each day, in four lowincome D.C. neighborhoods.

The medical team collaborates with the mobile dental unit, a clinical social worker, a family services associate, a patient liaison, and legal aid services, and provides help with taxi transportation with specialist appointments and inhome counseling.

“Not only do they have medical needs, but they have social needs that we try to fulfill because that impacts their health a great deal,” says Brown. “We try to make sure the whole person is taken care of. Substance abuse, mental illness, all of that affects their medical needs.”