Twenty years ago, the Family Van hit the road. Last month, the wellness services center on wheels celebrated two decades of providing free curbside health education, screenings and referrals to more than 40,000 people in Boston neighborhoods.
“It’s fascinating to think about what’s the same and what’s changed over 20 years,” said Jennifer Bennet, executive director of The Family Van and Mobile Health Map. “The program was designed by community members and in partnership with them, and to this day, that’s very much the way that we run the program.”
The Family Van was envisioned by Nancy Oriol, now HMS dean for students, who launched the project with co-founder Cheryl Dorsey, then an MD student and now the president of Echoing Green, a venture philanthropy. The Van hit the streets on Martin Luther King, Jr. Day in 1992, with a mission to increase access to health services in medically underserved neighborhoods. The Van originally served six sites; a seventh site, in East Boston, was added in October 2011.
Today, Van clinicians stay busy, sometimes seeing up to 30 people during a three-hour neighborhood stop. Much of the work involves undiagnosed chronic illnesses such as hypertension and diabetes.
Although Massachusetts has made health insurance more widely available, Van staffers stress that insurance does not translate directly to access to care. Last year, only eight percent of Family Van clients were uninsured. “We primarily are working with people who have coverage, but their lives are too complex, usually because of poverty, to access healthcare,” said Benet.
“Dean Oriol came up with a very elegant, user-friendly design,” said Caterina Hill, research and evaluation program manager for The Family Van and research associate in the HMS Department of Global Health and Social Medicine, citing drop-in appointments and free services. “Even in Boston with all the amazing hospitals, there’s still a need for mobile clinics as a means for providing outreach and between-visit care for health symptoms. The Van’s success is built on trust and on meeting people where they are, both geographically and in terms of their health.”
In addition to preventative screening and testing, health education and student training, the Van team has expanded efforts in research and analysis. Mobile clinicians now upload data using an online tool called Mobile Health Map. A return-on-investment algorithm developed at HMS analyzes cost savings. “Now we’re able to really play a national role,” Benet said, “in terms of helping other mobile clinics understand that they really are having an impact.”
To date, more than 450 mobile health vans across the United States are using the online service. “Any van across the country can use it,” Benet said. “And it has shed light on a community that was previously really unstudied.”
One in three Van clients, Hill said, learn for the first time that they have borderline or high blood pressure, total cholesterol or blood glucose. The Van offers referrals and lifestyle coaching. “We’re saving the city of Boston more than $1 million annually in avoided emergency room visits because we’ve been able to identify folks who are at high risk early on, and help them avoid becoming acutely ill,” said Hill.
Half of regular clients who presented with a health problem on their first visit to the Van controlled the condition by later visits. And savings aren’t just in dollars.
“This is a way to support the goals of primary care doctors, but we do so outside of a primary care setting,” Benet said. The Van team is moving in the direction of increased collaboration with care providers. “Doctors have an incredibly important role, and we need to make the best possible use of their time. Is it cost effective for doctors to be doing the education and counseling component of this part of treating people? Does that have to happen in a doctor’s office?” asked Benet.
“It was no accident that we were founded on Martin Luther King, Jr. Day,” said Hill. “Despite all the changes and growth, we’ve maintained the social justice aspect of our mission.”
—Angela Alberti
