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PCHS Mobile Program

Monday, October 14, 2019   (0 Comments)
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Authors: Anthony Lyon-Loftus, MPH, MSHS, PA-C, Associate Medical Director at PCHS and Jessica Qiam, PCHS Quality Department

 

Access

Peninsula Community Health Services (PCHS) seeks to provide accessible, affordable, quality health and wellness services for their community. They strive to value every person and eliminate healthcare disparities (www.pchsweb.org/about/)


PCHS developed their Mobile Program to focus on those that do not engage traditional primary medical (PCP) and behavioral health (BH) services.   A needs assessment of the community identified several barriers to include absence of affordable housing, food insecurity, limited transportation, lack of insurance, childcare shortages, difficult appointment times, mental illness / social anxiety, substance use, and past negative experiences.  As one mobile staff member pointed out, not everyone trusts the healthcare field, and many patients are overwhelmed by crowded waiting rooms, rigid scheduling, and the complex logistics/terminology associated with going to a clinic.


The January 2019 Point-In-Time count located 753 persons in Kitsap and Mason counties who identified as “homeless”.  Of those, 254 currently had no shelter or transitional housing (2019 WA Department of Commerce).   The Department of Human Services interviewed many of those “unsheltered households” of Kitsap, and over half had stable housing within Kitsap at some point.   Many reported being homeless due to Health Issues/Mental Health (34%), substance use and/or family conflict (38%) (2019 Kitsap County Point-in-Time Count).  More families are lacking consistent housing, food, and transport and are therefore increasingly unable to address their healthcare needs. 


And thus, The “A” Team (“ACCESS”) and The “W.O.W.” Team (“Wellness on Wheels”) were born.    


The “A” Team’s name capitalizes on the success of Mr. T and his soldiers of fortune in the 1980s, and its mobility expands the success of PCHS as a trusted, resourceful member of the community.  It is staffed by a rotation of three primary care providers (PCPs) and a steady medical assistant (MA).  In March 2019, the medical team began rotating between shelters, libraries, food banks, and communities of faith. 


The W.O.W. Team started shortly thereafter (April 2019) and strives to help those needing behavioral health (BH) services by bringing a comfortable space to a familiar location. The BH team includes a licensed counselor (LMHC) and chemical dependency professional (CDP).  The counselor is trained to help a wide array of psycho-social conditions and the CDP helps support people through their road to recovery.  They serve as a confidant and coach and engage those who do not excel in a more traditional setting.  The W.O.W. team is supported by a prescribing psychiatric provider who is available on an as-needed basis.  

 

Both teams include a Community Health Worker (CHW) who can help connect people with community resources and help navigate the daunting world of insurance. PCHS has a food insecurity program through which patients can access food more quickly.  


Both units have a balance of scheduled and same-day appointments to facilitate follow up when needed and to accommodate those in crisis who need help in a timely fashion.  They have started  to offer later hours so as to be available to those with work, childcare, treatment, or other daytime responsibilities.

 

 


 

Quality

PCHS has provided healthcare to their community for over 30 years.  They welcome anyone, regardless of life circumstance, but remain especially dedicated to the under-served.   In addition to their focus on access, PCHS remains committed to providing high-quality services as well.  They help address acute concerns before they become emergent, manage chronic illness before they get more complicated, and complete appropriate screening / health maintenance testing to help folks be their healthiest selves. 


PCHS is a certified Patient-Centered Medical Home (PCMH) and HRSA Health Center Quality Leader awardee. All PCHS sites (including mobile clinics) are accredited by the AAAHC (Accreditation Association for Ambulatory Health Care).  PCHS patients and providers have access to pediatricians, internal medicine specialists, psychiatry professionals, counselors, chemical dependency professionals, clinical pharmacists, nutritionists, dentists and dental hygienists, and insurance navigators.    


PCHS mobile services are unique in that they can deliver that breadth of opportunity, in a tangible beacon of hope, right to the feet of those who need hope the most.  The mobile clinics provide enough privacy for sensitive conversation, and also enough flexibility to engage folks at a time and place that is convenient for them.   If further needs are identified that cannot be addressed on the mobile clinic, the mobile team can utilize PCHS’s wider connections to help a patient get the most appropriate services.  


With some frequency, it is not medical or behavioral health services that mobile clients need most.  Many times, the mobile staff help patients connect with insurance, food, shelter, transportation, or help them overcome misperceptions about themselves, their community, or the broader healthcare field. 

 

 

Sustainability

The PCHS Mobile Program serves areas throughout Kitsap and Mason counties. This includes the city of Bremerton, where roughly 58% of Kitsap’s unsheltered homeless community currently reside (2019 Kitsap County Point-in-Time Count).   This relatively high concentration of folks-in-need allows PCHS to have a profound impact here and helps to offset the cost of serving more remote locations as well. 


In keeping with the desire to balance cost with convenience, the Mobile Program’s schedule is loosely tied to the “Free Meals of Kitsap” calendar.  This leverages an already-existing network of community partners and is a great opportunity to connect with groups of folks in need… and what doesn’t go better with food!?


In 2018, the Kitsap County Board of Commissioners awarded Peninsula Community Health Services with funds to support its Behavioral Health Mobile Unit.   PCHS hopes that once the program is fully established it can remain sustainable from revenue generated by visits and not rely on grant funding going forward.   It is already offsetting the cost of rotating sites by offering later hours and same-day appointments.

 

Secondary Benefits

 

While the focus of the PCHS Mobile Program is to serve those unwilling and/or unable to engage care in a traditional clinic setting, there have been some definite associated wins along the away.  

Resource utilization – By making primary care and behavioral health services more accessible, the PCHS mobile clinics can prevent some unnecessary use of emergency services (police, fire, ambulance, ER, etc). 

Paperwork / logistics – even if they are not initially seen by a Mobile practitioner, the Mobile staff can help patients sort out insurance hurtles and complete important paperwork.  This allows them to hit the ground running when they do formally engage services (at Mobile or traditional clinics). 

Scheduling Flexibility – When PCHS patients are interested in same-day appointments and there is no availability at traditional clinics, they can be routed to the Mobile clinics.  This open concept is also helpful during transitions back into services upon release from jail or the ER.  Priority is still given to those who are onsite already and/or can only access mobile services. 

Integrated communication – The Mobile Program has showcased just how beneficial PCHS’s integrated model can be.  The shared Electronic Health Record (EHR) allows the Mobile Team to access notes from a patient’s PCP, BH team (CDP/counseling/psychiatry), OBGYN, pharmacy, cell center, etc.   This is especially helpful for clients who do not have a reliable phone or address. 

Advertising – the two large, bright-green units driving around the Peninsula have undoubtedly drawn attention to PCHS and the services it has to offer.   Media engagement has also helped with community awareness about PCHS and its Mobile Program.  Links below to several articles from The Kitsap Sun.

Partnership building – The Mobile Program has helped establish and strengthen partnerships between PCHS and many other local organizations who are trying to make a difference.  PCHS has been very fortunate to have several community partners agree to “host” the mobile clinics on a recurring basis – without them, the Mobile Program simply could not thrive.  

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Links of interest: 

  1. www.kitsapsun.com/story/news/2018/08/20/bremerton-peninsula-community-health-awarded-quality/1046738002/
  2.  www.kitsapsun.com/story/news/local/2019/03/02/peninsula-community-health-services-rolls-out-mobile-clinic/3005165002/
  3.  www.kitsapsun.com/story/news/2019/06/04/pchs-bus-hits-road-provide-mental-health-care/1334087001/
  4.  www.kitsapsun.com/story/news/2019/07/14/peninsula-community-health-services-plans-behavioral-health-hub/1711492001/
 

 

 

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