Mobile Person-Centered Care at Patient’s Place!

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May 30, 2023

By Jeyanithe Karunanithy, BA (Hons), MSc, Inter-Professional Primary Care (IPPC) Team

“The mobile health van program is wonderful as it is geared towards “low-income”, marginalized communities or at-risk populations like me; it is in fact a stepping stone for people who are living in the government’s housing. In our building, many residents come across various barriers to access healthcare including family doctors or a psychiatrist. We face issues in commuting to attend other healthcare appointments such as mental health counseling or addiction treatment. I am happy to say that I am forever grateful to be one of the many people whose life will get better with the support of this mobile healthcare.”

A mobile health van service user, May 22, ‘23

In today’s precarious healthcare environment – especially in the context of the COVID-19 (post?) pandemic and mental health and addiction crises – convenient access to advanced psychosocial support or addiction care and harm reduction are fundamental to achieving community health and well-being. That is why Scarborough Centre for Healthy Communities (SCHC) keeps introducing innovative and timely initiatives like low-barrier mobile healthcare involving its specialized healthcare professionals across the city. 

In January 2022, with the generous support of the Government of Canada’s Emergency Community Support Fund and Toronto Foundation, SCHC formed the Mobile Health Unit (MHU), in response to needs within Scarborough, where community residents find it challenging to use traditional support options or access specific locations conveniently. The purpose of the MHU is to take care of the changing needs and new concerns of people by providing convenient, accessible mobile healthcare services; and in doing so, the mobile health van staff are meeting individuals where they are residing. A group of trained healthcare providers, (e.g., Harm Reduction Worker – HR and Mental Health Case Worker – MHCW) from the Inter-Professional Primary Care (IPPC) team reaches out to the community residents by the mobile health van shifts (MHV) on a weekly basis. Staff at the Diabetic Education Program (DEP) also join the team once a month, supporting the HR & MHCW, traveling in a semi-customized vehicle to meet the community’s most marginalized including individuals experiencing chronic poverty, homelessness, substance use, and mental health challenges in order ensure convenient access to healthcare.

Currently, the MHU is providing the core service of distributing materials for basic needs (e.g., hygiene products, snacks/food, hats/socks, sleeping bag, etc. – the exact materials vary by season and by availability) and for harm reduction (e.g., materials for safer drug use including Naloxone kits, condoms, etc.,) and first aid items like band-aids and so on. The healthcare workers on duty provide on-the-spot counseling/advice on mental health and addictions matters including service navigation/referrals around harm reduction and overdose prevention, among other important services as well.

The MHU provides services to four regular locations on a weekly basis for approximately one hour.  The MHU also provides case management support ad hoc (e.g., when there is enough staff, the mental health caseworker interacts with service users to inform them of further programs and services, makes referrals, etc.) and DEP program promotion monthly. The number of clients who access MHU services not only continues to increase increases but it also varies by season. 

See the table below that shows the seasonal average clients per stop:

Location	Time	SpringAve. # of Clients:	SummerAve. # of Clients:	FallAve. # of Clients:	WinterAve. # of Clients:
4175 Lawrence	Mondays from 1:00 – 1:30 PM	31	40	29	26
4205 Lawrence	Mondays from 1:40 –  2:10 PM	31	32	21	17
10 Glen Everest	Tuesdays from 12:30 – 1:30 PM	12	14	14	12
50 Tuxedo	Thursdays from 1:00 – 1:30 PM	37	46	44	36
(Hub Outreach)	TBC	–	–	–	–

Source: Dawkins, J. Mobile Health Unit (MHU) Experience and Feedback Survey (Evaluation), March 2023, SCHC.

According to a recent survey/evaluation of service users’ experience of the MHU, overall people are appreciative and grateful for the MHU and had positive things to say about the service and staff. Most of the service users (about 70 percent) agree that they are receiving the services that they come to the MHV for; that they are satisfied with the services provided; that they have enough time with staff to ask questions; that staff are approachable and supportive; and that SCHC is very reliable as a service provider. 

Many community residents affirm that SCHC’s MHU plays an important role in raising awareness of primary health care, psychosocial support system, and harm reduction methods by sharing information about its own programs and services spread across the 10 different locations by visiting the people in need at their places and building relationships with those coming to the mobile health van. In its first 12 months of operation, the MHU have had thousands of engagements with service users; it served over two hundred people, providing them with on-the-spot education, screening, and treatment for harm reduction/mental health/diabetic conditions; in addition, the program distributed over thousands of Naloxone kits, apart from the provision of essential daily products. 

The MHU offers services appropriate by environment (i.e., primarily focusing on resource distribution, e.g. harm reduction and essential items along with a secondary focus on providing information (i.e., promoting programs and navigation support, e.g. referrals). Currently, the service is taking place in a limited capacity (i.e., monthly by DEP; MHCW on van weekly usually supporting resource distribution and service navigation/referrals). Meanwhile, the MHU is limited to providing brief intercept-type interactions that do not involve discussing personal or sensitive information now. Other services need to consider what is appropriate in terms of privacy, exposure to weather, timing, and frequency, repeat clients, complexity of needs, etc. Some clinical services are not appropriate but can explore alternatives (e.g., using space inside buildings). 

Nevertheless, the MHU continues to work on expanding its services to offer a variety of low-barrier services by adapting and learning as it goes (i.e., monitoring and revisiting as new locations or new services are added). This includes using the MHV as a mobile option for an on-site temporary medical clinic or private treatment space and safe on-site working area, by (re)designing it as a mobile health clinic with both practitioners and patients/clients in mind. In this way, the MHU could provide additional services staffed by a physician/assistant, registered nurse, occupational therapist, dietician, foot care specialist, and other healthcare services including Hep C testing (POC) and HIV screening while DEP services could transition into education session inside a building. 

Consequently, the MHU allows various programs at SCHC to provide better services for many hard-to-reach and vulnerable individuals that often do not have access to such healthcare services. Both providers and service users at the MHU attest that bringing health care to the community residents can improve health outcomes and trust in the overall healthcare system. Further, it is evident that the MHU services have begun to reduce health disparities in vulnerable, at-risk/marginalized, and remote populations because the mobile health van shifts enable convenient access to psychosocial support and addictions/harm reduction care often taking away the need for clients to travel to an office environment or a static clinic set up. 

What sets SCHC’s MHU apart is that not everyone has convenient access to a traditional healthcare office; under the circumstances, the mobile health van help bridges that gap by providing easy, safest, and most effective mobile healthcare solutions, especially convenient access to healthcare providers and services in our community. Mobile health vans also help lessen the often-lengthy downtime between appointments and the stigma attached in terms of seeking help for substance use or addiction problems and not to mention mental health matters and make it easier for people in smaller and underserved communities to attain healthcare services they need/deserve. Finally, the MHU’s method of providing healthcare helps foster supportive provider-to-patient/client relationships because the program requires providers to go to patients/clients’ places which helps providers gain leads and get to know their patients/clients better.