The Illinois Mobile Healthcare Forum Anthony Vavasis, M.D. Clinical Director Health Outreach to Teens Program New York, New York Advisory Board Chair The Mobile Health Clinics Network Mobile Health Delivery: The Critical Importance of Process

A Very Short Story, Part 1 You are running out the door of your home, late for a meeting, when a car pulls up in front of your house. A man gets out wearing shorts, a T shirt and sandals and unloads a box of books from the trunk of his car. You remember that your next door neighbor told you not to answer the door if you see an encyclopedia salesman ringing your bell. He stops you as you exit your house and tells you that he is selling new 1988 Edition World Book Encyclopedias for $1000.

A Very Short Story, Part 2 His first language is Greek, and he is having difficulty explaining in English why you might want to make a purchase. When you tell him you are having difficulty understanding him, he expresses dismay that you don’t speak Greek so that you could understand him better. When you decline the purchase, he persistently attempts to make you feel guilty for not buying his encyclopedias after he went out of his way to try to sell them to you.

Encyclopedias, anyone?  What are reasons why you didn’t make this purchase?  What mistakes did the salesman make?

What is ‘Process’? proc·ess A series of actions, changes, or functions bringing about a result: the process of digestion; the process of obtaining a driver's license.

The Salesman’s Process  Timing  Presentation  Accessibility  Reputation

The Salesman’s Process, cont’d  Communication  Expectations  Relevance

Speaking of Relevance... What do encyclopedias have to do with mobile health?

Story Substitutions You are running out the door of your home, late for a meeting, when a car pulls up in front of your house. A man gets out wearing shorts, a T shirt and sandals and unloads a box of books from the trunk of his car. A Spanish-speaking migrant worker is running out the door of his trailer, late for work, when a mobile health van pulls up.

Story Substitutions A Spanish-speaking migrant worker is running out the door of his trailer, late for work, when a mobile health van pulls up. A man gets out wearing shorts, a T shirt and sandals and unloads a box of books from the trunk of his car. A doctor gets out wearing shorts, a T shirt and sandals and stands up an old sign that says “Get Health Care Here”.

Story Substitutions You remember that your next door neighbor told you not to answer the door if you see an encyclopedia salesman ringing your bell. He stops you as you exit your house and tells you that he is selling new 1988 Edition World Book Encyclopedias for $1000. The worker remembers that his workmates told him that he should avoid a crazy doctor with sandals who provides health care from a van. The doctor tells the man that he’s a pediatrician but that adults are just big children. The care is only $50 per visit.

Story Substitutions His first language is Greek, and he is having difficulty explaining in English why you might want to make a purchase. When you tell him you are having difficulty understanding him, he expresses dismay that you don’t speak Greek so that you could understand him better. The doctor’s first language is English, and he is having difficulty explaining in Spanish more about the services that he provides. The man tells the doctor that he is having difficulty understanding him, and the doctor asks indignantly “Why don’t you speak better English?”

Story Substitutions When you decline the purchase, he persistently attempts to make you feel guilty for not buying his encyclopedias after he went out of his way to try to sell them to you. When the man tells the doctor that he doesn’t want medical services, the doctor states that he could work in a nice medical office but wants to help people in need.

Process in Program Design 1. General staff conduct 2. Needs Assessment 3. Policies and Procedures 4. Vehicle Design 5. Relationship Building 6. Content of Visit Why are we here today?  Learn from each other  Use this information to improve our programs  Build collaborative relationships

Process in Mobile Health, examples:  Staff conduct  Needs Assessment  Policies and Procedures  Community Collaboration

General Staff Conduct By definition, outreach:  involves entering a community with its own culture  switches the minority and the majority cultures  requires careful attention to personal conduct

1. Humility –  willingness to learn from clients  openness to adapt oneself as care provider Four Key Elements to Conduct

2. Tolerance –  social norms may be different from one’s own  staff should contain judgments Four Key Elements to Conduct

3. Boundaries –  staff should always maintain professional boundaries Four Key Elements to Conduct

Process in Program Design 4. Awareness of Power –  economic  professional  mobility (ie. ability to leave community) Four Key Elements to Conduct

Needs Assessment It is imperative to understand the target population:  learn about gaps in services  learn what the barriers are to accessing traditional services

Policies and Procedures Must recognize context of target population:  Can they afford the service?  When is service provided?  How are people registered?  Are there supervisory or security issues?  To what other organizations are the visits reported?

Community Collaboration Reputation and first impressions matter  “representatives” may be sent to learn about program  each early client should be understood as crucial to public relations efforts for the van

It is essential that outreach program acts as guest to be welcomed in community, not as rescuer. Community Collaboration

In Conclusion Good Process will:  build trust  build continuity  and ultimately build a solid program Bad Process will prevent the program from ever starting.

In Conclusion – Story Rewrite A Spanish-speaking migrant worker is running out the door of his trailer, late for work, when a mobile health van pulls up. A doctor gets out wearing shorts, a T shirt and sandals and stands up an old sign that says “Get Health Care Here”. The worker remembers that his workmates told him that he should avoid a crazy doctor with sandals who provides health care from a van. The doctor tells the man that he’s a pediatrician but that adults are just big children. The care is only $50 per visit.

In Conclusion – Story Rewrite The doctor’s first language is English, and he is having difficulty explaining in Spanish more about the services that he provides. The man tells the doctor that he is having difficulty understanding him, and the doctor asks indignantly “Why don’t you speak better English?” When the man tells the doctor that he doesn’t want medical services, the doctor states that he could work in a nice medical office but wants to help people in need.

Thank you for your attention and participation. Enjoy the Forum!