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Taking Health Care On The Road

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SCHOOL BUS DRIVER
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With our health care system facing ever-increasing demands and mounting budget constraints, we need to think differently about how we deliver health care. As we've seen in our series on change agents, this is precisely what change agents do -- they make a difference by doing things differently.

The next change agent I'd like to profile is hitting the road -- literally -- to improve health care via a health clinic on wheels that helps vulnerable youth. Mobile health units or MHUs continue to gain momentum as an innovative way to fill important gaps in health care.

Like the other innovations in the series so far -- a pop-up clinic and social enterprise initiative -- MHUs take health care in a much-needed new direction. Case in point: the Calgary-based Alex Youth Health Bus -- a graffiti-covered bus equipped with music, snacks, comfy chairs, and friendly staff -- that provides health care and support to youth when they need it and where they need it.

A not-for-profit organization, The Alex Community Health Centre has provided health care and housing support to Calgary's most vulnerable residents for over 40 years. In 2012, in collaboration with the Calgary Board of Education and a range of youth organizations, The Alex launched the Alex Youth Health Bus as a way to reach young people who face challenges accessing health and social supports through traditional settings.

The staff member driving the bus, Lyndon Ulmer, is also driving change as the client resource specialist on the bus. Although some change agents establish and oversee healthcare innovations, others are the unsung heroes on the frontlines who use their strong interpersonal and problem solving skills to become a catalyst for change. This is definitely the case as Lyndon figures out how to help young people with whatever they may need and becomes a supportive, reliable, and trustworthy adult in their lives -- sometimes one of the few they have.

A mobile health unit first
First of its kind in Canada, the bus with Lyndon and a doctor and nurse on board visit the same eight high schools each week delivering health and support services right in the school parking lots. The bus always keeps the same schedule, rain or shine (or snow) so the students know they can count on the team to be there each week.

"We help a variety of youth who are potentially facing barriers like poverty, lack of supports or connections to health care or mental health issues that, without help, may prevent them from growing into healthy, independent adults," says Lyndon. "Also, many of the kids [we help] are what we call 'vulnerable' or 'at-risk of being at-risk.' They are often right at the tipping point; we catch them before they fall through the cracks."

Coping with mental health issues or the risk of sexually transmitted infection or pregnancy, or physical ailments, many students feel they can't access traditional health care settings. They are intimidated, may have had a bad experience with the current health care system, or worry about being judged. Fortunately, because the bus brings health care to them rather than the other way around, they get to choose how and when they access the help they may not otherwise have received.

In addition to physical care that includes education and treatment regarding sexually transmitted infection, birth control and mental health, and general health and wellness, the bus also provides much-needed emotional, psychological, and social supports.

Referrals are made to health and therapy-based programs, social programs like foodbanks and housing initiatives, as well as other programs within the Alex itself like their youth health centre.

This is all part of taking a 360-degree approach to care that looks at each student's range of individualized needs. This has led the bus in different directions providing help that is as unique as the students themselves.

No such thing as a typical day
Students simply sign up at school, without having to give a reason for visiting the bus; everything is confidential. In shorts and hi-top "old school" converse shoes (nothing formal or "establishment"), Lyndon makes each student feel comfortable as they head out to the bus. "I just try to get them talking about anything.

They may talk about their family and friends or they may just tell me about random things like their pets or sports and music they like. The main thing is that I listen. I treat each student with respect and compassion, and let them know that they matter, and that they have a safe place on the bus to provide a sense of belonging as well as health care."

Lyndon's actions speak volumes as the students quickly realize that he is someone they can count on. Often Lyndon and his team become an integral part of the students' school lives, even though the bus is only at their school weekly or bi-weekly. When the bus is not at the school, the students know that the team is only a phone call or text away to get support during the school day. For any after-hours needs, the students are connected to other community resources so they always have somewhere to go for support, and so they can become more independent in their self-care.

Making the road to change less bumpy
By using the innovation of a mobile health unit, the Alex Youth Health Bus is appealing to students so they get the help they need; they don't think of it as going to the doctor. It seems to be working - the Alex youth bus had 2,800 visits during the last school year.

Lyndon elaborates, "It really does take a village to raise a child so being part of a team makes a big difference. We have the bus team, and the team of The Alex, the schools, the school board, the other youth organizations, and the students themselves. The students aren't 'clients,' we all work together as a team."

Sarah Saso is Managing Director of Social Innovation at Green Shield Canada (GSC). The Social Innovation team supports GSC's mission -- to make health care accessible to all Canadians -- by building community capacity, strengthening public policy, and advancing knowledge in the health care field. The Change Agent series aims to shine a light on the people and the organizations committed to creating innovative solutions that improve access to better health for marginalized Canadians and drive big picture change in Canadian health care.

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