Access to Medical and Behavioral Care For Children: A National Crisis

A primary goal of the U.S. health system is to provide affordable, value based, accessible care. Healthcare services are largely provided by hospitals and clinics, yet, among all of the methods for healthcare delivery mobile health clinics are the most effective in providing care to underserved children, offering a unique solution to expanding health equity and improving quality of care. There is a growing emphasis by the healthcare community to provide more stable medical services to children, particularly post pandemic.

In September 2023 the Centers for Medicare & Medicaid Services announced, “the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), sent a letter to state health officials reinforcing that states must provide 12 months of continuous coverage for children under the age of 19 on Medicaid and the Children’s Health Insurance Program (CHIP) beginning January 1, 2024”. CMS Administrator Chiquita Brooks-LaSure stated: “CMS continues to work to increase access to health care services for children in ways that reduce disparities and build a reliable health safety net for every young person”.

According to a new report published by the National Association of Community Health Centers approximately one third of Americans do not have adequate access to primary care and about twenty-five percent of those are children. That’s nearly 25 million kids.

But how do we reach disenfranchised children who are in vital need of healthcare services? For decades children’s hospitals, universities, primary care facilities and other healthcare institutions have been using mobile health clinics to meet this need.

Mobile clinics are equipped to offer multiple levels of services to children, from dental to basic screenings, and comprehensive primary care to developmental issues. Mobile health clinics are often the only lifeline for children’s medical needs in rural and urban underserved communities.

Children’s Mental Health is in Crisis

Stability in one’s environment plays an important role in overall health. And the biggest impact on kids’ health in recent years has been the lasting effects of mental health issues brought on by the COVID-19 pandemic.

However, according to the United States surgeon general children and teens have been suffering for far longer and is only getting worse. As reported by the American Psychological Association, and the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System the decade leading up to the COVID-19 pandemic witnessed an increase of 40 percent of American youth experiencing a higher rate of sadness and hopelessness, along with suicidal thoughts and behaviors. And the pandemic has only made it worse.

“We’re seeing really high rates of suicide and depression, and this has been going on for a while, and it certainly got worse during the pandemic.” said psychologist Kimberly Hoagwood, PhD, a professor of child and adolescent psychiatry at New York University’s Grossman School of Medicine.

The normal ups and downs of childhood and adolescence can feel insurmountable enough. Yet the pandemic brought about increased social isolation and academic disruption for children and teens as well as many losing caregivers, parents losing their job and an increase in emotional or physical abuse at home. Couple this with the impact of social media, hysteria brought on by mass violence in schools rippling through districts all over the country, an increase in natural disasters and even political polarization that kids are not immune to.

It’s up to the healthcare community to literally mobilize in an effort to reverse this downward spiral our children are caught in.

Providing Solutions

The Children’s Hospital Association serves as the voice for over 220 children’s hospitals in an effort to advance healthcare through innovation in the delivery of services in children’s health systems. The association, with many of its member hospitals, leverage mobile health clinics to “flip the patient-provider dynamic on its head” for:

Addressing social factors affecting children’s health
Improving equity and outcomes among patients regardless of their social or economic status
Overcoming barriers to care regardless of where they live

Of the thousands of mobile health clinics operating in the U.S. it’s estimated they serve at least 5.2 million visits annually, of which 2.1 million are for children. Yet approximately 22 percent, or 73 million Americans are under age 18, and sadly this age group represents 32 percent of all people in poverty. With a population of 332 million, 11 million U.S. children live in poverty and often do not have access to adequate healthcare.

On the Frontlines of Mobile Access for Children

In addition to providing much needed medical services many children’s mobile clinics unite patients with other community resources such as housing assistance, food banks and even speech therapy. They also help kids learn how to overcome behavioral health challenges and improve school performance.

Examples of organizations providing children’s mobile health services include:

Ronald McDonald House Charities, based in Chicago, is one of the largest single sponsors of mobile health clinics for children. Each Ronald McDonald Care Mobile® unit is operated through relationships with independent clinical service providers who bring an extensive network of medical, dental, behavioral and other health care resources to children in underserved communities throughout the world.

Children’s Health Fund serves children “in under-resourced communities with a coalition of 25 national network programs in 15 states, D.C., and Puerto Rico that deliver care through its fleet of more than 50 mobile medical clinics.”

MedStar Georgetown University Hospital, a division of Community Pediatrics, takes a unique approach in utilizing its Ronald McDonald Care Mobile unit to provide comprehensive children’s health services through their well-defined Five Pillars of Health:

1) Physical	2) Mental	3) Oral	4) Nutritional
5) The impact of the Social Determinants of Health (i.e., schools, environment, etc.)

The Heritage College mobile clinics at Ohio University have been providing quality medical care services with two 40-foot mobile clinics to rural residents of southeast Ohio and beyond since 1994. These mobile clinics focus on:

Free primary care for underinsured or uninsured children and adults
Immunization clinics for children and adults
Services at public school systems, including school bus driver physicals

KIDS Mobile Medical Clinic/Ronald McDonald Care Mobile® offers services for children who have Medicaid, don’t have any insurance or don’t have access to a doctor’s office close to their home. They provide a wide variety of services to promote better health in children, including:

Checkups	Vision and hearing	School physical exams	Child advocacy	Referral to specialists
Mental health screening and referral	Sick visits	Routine immunizations	Health education

The Nationwide Children’s Mobile Care Clinic serves neighborhoods and communities visiting schools, childcare centers, churches, community events and family shelters. The mobile medical clinic makes it easy for children and families to receive outstanding healthcare services with state-of-the-art medical equipment and highly trained staff. They make a smooth path to medical services by excepting Medicaid and all other insurances.

Cost Benefits of Operating a Mobile Health Clinic for Children

The U.S. mobile health clinic market was valued at USD 1.66 bn in 2022, with an anticipated compound annual growth rate of 11.2 percent from 2023 to 2030. This estimated market expansion is due to the increasing demand for alternative healthcare delivery services for providing preventive care solutions such as screenings, dental checkups, vaccinations, chronic disease management and to address mental health. According to a study by the International Journal for Equity in Health, the COVID-19 pandemic had a significant impact on the U.S. mobile clinic market by driving an increased demand for accessible and cost-effective primary care solutions. Mobile medical units cut costs to the healthcare system by preventing an estimated 600 emergency room visits each year and they provide a substantial revenue stream for healthcare institutions.

Mobile medical clinics can be very profitable and contribute to the overall business mission by allowing institutions to reach many more clients. They serve as patient referral opportunities, a roving billboard advertising the institution and an added revenue stream.

To facilitate the growing need, governments have increased funding for mobile clinics at both state and federal levels. Grant and funding resources include:

Additional Sources Include:

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Access to Medical and Behavioral Care For Children: A National Crisis