Goals

1. Improve access to care barriers.
2. Decrease emergency room visits.
3. Keep children healthy and in school.
4. Connect children to a primary care medical home and other needed resources. 

Considerations

Partnering with schools and agencies: Very helpful in establishing trust and identifying children most in need of healthcare, and a good way to ensure that children who are out of medical compliance are able to stay in school. 

Coordination: The best person to coordinate visits may not be the school nurse but rather, say, an office clerk who is more familiar with families.

Advance: Pick up paperwork a week in advance to ensure that medical and immunization records are current and to give enough time to reach families with discrepancies. It is also helpful to standard communication regarding parking, what paperwork is needed, etc. to ensure overall success. 

Communication: Most parents are reachable via phone numbers. If their phone number is currently not in service, the schools generally have up-to-date contact information. Parents are also more likely to pick up the phone when the school is calling. 

Parent/Guardians presence: Decide whether you a) will require parents to be present so they can give histories and learn about well care; or b) conduct exams without parents present because of the challenge for working parents to attend appointments (and any history is obtained via the consent form and/or calling prior to the visit). 

Weekend, vacation and summer locations: To reach children when school is not in session, attend health fairs (scheduled throughout the summer) or park in front of WIC Programs, Head Start centers and other community locations such as libraries, churches or community centers.  (which operate year-round).  

Vaccines: Immunizations pose a considerable challenge because proper storage and handling can be challenging. Clinics must be outfitted with proper refrigerators, freezers and logs. In addition, after-hour handling must be considered: Will you load them every day or keep them onboard the mobile? The latter requires that you ensure that the power source is safe and there is a backup supply. One clinic lost more than $50,000 worth of vaccinations in two incidents because the building where they parked and plugged into lost power overnight. 

Medications: Many parents can’t afford even lower-cost over-the-counter medications, so consider stocking a mobile dispensary to distribute medicines for free. When storing, consider the temperature on the vehicle to ensure proper temperature ranges. Also, determine who has access to the medications and how they will be locked.

Staffing: Because the clinic is not stationary, staff must be highly adaptable and expect cross training of roles and responsibilities, like a driver who is also the registrar/EMT. A general staffing model includes a driver, medical assistant and nurse practitioner, students if it is a teaching program (like residents or nurse practitioner students). Additional staff can include volunteers, social workers, managers, or other providers (dentist, medical director, etc.).

Referral partners: Because a permanent medical home is important for health outcomes, try to establish relationships with clinics and other doctors’ offices within the geographic area to whom you can refer patients. It can be useful to let them know you are not trying to be a medical home, but rather provide additional resources. Other referrals such as mental health services or other specialty care are important; considerations should be made on how to best refer patients with those needs. Mobile health clinics are also looking at how social determinants affect their patients. This means that referrals could also include access to food, housing, etc.   

Materials: Consolidating all necessary school and sport forms—vaccination, physicals, recommendations—into one packet can be extremely helpful for families. It is also a good way to highlight missing information. Ensure all materials reflect languages spoken. 

Parking: Parking sites will need to be considered. Often, people at the site do not think about height or how the vehicle turns so provide clear instructions for parking needs to avoid issues on the day of service. 

Resources 

• Mobile Health Map 
• The scope and impact of mobile health clinics in the United States: a literature review
• Chricahua Community Health Centers Adolescent Van (requires membership)

Next Steps

• Become a member of Mobile Healthcare Association
• Join the Pediatrics Special Interest Group
• Review our start-up resources, some for members only.