Children's Hospitals Today - Winter 2023 - 28

FEATURE / MOBILE HEALTH
involves scheduled sessions at the
school that take place over the course
of two to three months.
In Houston, there are large populaYou
can't change the entire world with your mobile clinic,
but you can change the lives of some people every day.
tions of immigrants who avoid health
clinics and hospitals out of fear, confusion,
or lack of transportation. " A
lot of our patients will probably never
see a physician again despite our efforts
to get them into a medical home, "
Misra says. " That's why we decided we
needed to be comprehensive. " Their
main mobile unit has all the capabilities
of a pediatrician's office, and even
a pharmacy. Misra will fill prescriptions
during the visit so the patient
leaves with the medication rather
than having to travel to a pharmacy.
They also have a behavioral health
unit focused on trauma and grief to
help meet the increased need for pediatric
behavioral health care.
Although mobile health clinics
meet people where they are to provide
the care they need, their ultimate goal
is to connect patients to a permanent
medical home. Le Bonheur Children's
and Texas Children's mobile health
programs have at least one community
health or social worker who helps
families without insurance enroll in
Medicaid, CHIP or other insurance.
They assist with the required paperwork,
and they go the extra step of
connecting them to a medical home-
and verifying that they go. " We're
trying to reduce as many barriers as
we can, " says Misra. " They are barely
making it to see us. "
Meeting social needs
While the pandemic shed light on
existing gaps in health care access,
it also raised awareness of longstanding
disparities based on social
determinants of health (SDOH).
Strategies to overcome these disparities
require interventions tailored to
individual social contexts, which puts
mobile clinics in a position to address
those needs. " By integrating into communities,
mobile health clinics are
uniquely situated to improve equity, "
Wallace says. " Most mobile clinics are
looking at a whole person approach,
whether it's facilitating access to
healthy foods or safe housing, or providing
medical-legal partnerships or
behavioral health services. "
This is especially true for mobile
clinics run by children's hospitals
and health systems, which are widely
GETTING STARTED
Frequently
asked questions
WHO TO SERVE?
The population a mobile
clinic serves depends on the
goals and resources of each
children's hospital, but some
non-clinical indicators to
look for, according to a report
from Mobile Health Map, are
areas with transportation
barriers, shortages of
providers, and high utilization
of community resources.
Clinical indicators could
include high readmissions, low
outpatient visits, and high ED
utilization and costs. Talking
with community organizations,
schools, managed care
organizations, and insurance
companies can also provide
insight into populations or
conditions that could benefit
from a mobile clinic.
HOW TO STAFF THEM?
There are many ways to staff a
mobile health clinic. A common
approach is to have a dedicated
nurse, nurse practitioner and
driver, with the rest of the staff
rotating. At Lurie Children's,
one of 10 rotating urgent care
physicians will serve once a
week. Le Bonheur Children's
has LPNs alternate between
the mobile unit and the office
in addition to a dedicated
NP. Texas Children's clinic is
staffed by Baylor College of
Medicine faculty who spend
their clinical time on the
mobile clinics. They also have
three licensed social workers
for the trauma and grief
unit. All the hospitals have
community health workers who
split time between the clinic
and hospital.
WALK-INS OR
APPOINTMENTS?
Walk-ins allow people to
receive care who may not
have been aware of the clinic
ahead of time-but this
can result in people being
turned away due to time
constraints or only a handful
of patients showing up for
the whole day. Appointments
ensure everyone gets seen,
the required documentation
happens before the visit, and
enough patients show up to
make the trip effective.
TO BILL OR NOT TO BILL?
Although mobile clinics are
financially supported by a
combination of sources, for
some children's hospitals,
billing insurance is necessary
to remain sustainable.
(Most mobile clinics run by
children's hospitals do not
require any payment from the
patients themselves). Billing
can be a burden for mobile
clinics, and in Texas Children's
experience, fewer patients
come when they are billed
because of the documentation
requirements.
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CHILDREN'S HOSPITALS TODAY Winter 2023
Children's Hospitals Today - Winter 2023

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