In the course of just one month, Seth Ammerman can be found anywhere from the San Jose Emergency Housing Consortium to the Boys and Girls Club of the Tenderloin district in San Francisco. He travels widely as part of the Lucille Packard Children Hospital’s Adolescent Outreach Program. Driving to shelters, agencies and continuation schools in the Teen Health Van with three other staff members, Ammerman is able to provide homeless and uninsured adolescents with free medical evaluations, medications and arrangements for future treatments.

“Mobile medical care really helps by going to the kids where they are,” Ammerman said. “It really enables kids to get the health care they need, and eliminates a lot of barriers.”

Ammerman, an associate clinical professor in the Department of Pediatrics and a staff member at the children’s hospital, spearheaded the idea for the van after the hospital received a $5,000 donation from Blue Shield, a medical health insurance provider.

Ammerman was also aware that there was a strong local need for adolescent health care.

“In 1995, the United Way in Santa Clara county did a community needs assessment and it showed that adolescents were the most underserved population in terms of health care,” he said. “I was able to persuade the hospital to expand the mobile program to include a teen component.”

When the program began in 1996, the van made trips once a week to Santa Clara County, targeting uninsured and homeless youth.

“Before the program started, I did a lot of networking with agencies to see who was already serving these groups and talked with youths themselves,” Ammerman said. “One of the things that everyone mentioned was that it was important to offer comprehensive services and as many services as we could at the same time, so that the youth wouldn’t have to go to many different places to get the treatments they needed.”

The van, which carries most of the commonly needed medications on board, is staffed by a nurse, a social worker and a dietician, in addition to Ammerman.

Ammerman said that the van deliberately staffs a female practitioner as well as a male, due to the fact that some youths have had traumatic experiences with members of a particular sex. Offering the choice of a male or female physician, he added, is very important in terms of building trust with the practitioners.

Ammerman also stressed the importance of having a social worker because many of his patients struggle with psychological issues. Additionally, having a nutritionist on board has proved to be useful because the teen years are an important period for growth and development and eating well is particularly important at this time.

In the van, Ammerman says he treats “typical teen problems like acne, headaches, menstrual cramps and birth control” in addition to more serious issues such as “depression, anxiety and other mental health disorders.”

He added that the program offers a lot of health education, including prevention and risk-behavior reduction. The van’s staff also tries to help their patients by finding appropriate agencies, schools or jobs for them.

The van, which Ammerman describes as “a mobile home with clinical exam rooms,” currently goes out two days a week to six different sites a month, and now reaches San Mateo County and San Francisco, in addition to Santa Clara County.

“Consistency is very important,” Ammerman said. “We go to the same sites on the same days of the week on a consistent schedule so that the kids know that we’re going to be there, and the agencies know that we’re going to be there.

“Once a kid is in our program, they can come to any site and we arrange for transportation,” he added. “The majority of the kids we see do quite well and that’s really what keeps us going.”

One female teenager, Ammerman cited as an example, came by to check out the service and left with a positive pregnancy test.

“She decided to continue the pregnancy, got prenatal care and stopped smoking,” Ammerman said. “This was a very good outcome.”

Ammerman also mentioned another female teen who was depressed and engaging in risky sexual behavior. She was also suffering from substance abuse, asthma, headaches, menstrual cycle problems and malnourishment.

“We were able, over time, to get to know her and get her back in school,” Ammerman said. “She graduated, got a job and recently was employee of the month. She stopped all her substance abuse except tobacco, and became much more responsible about her sexual behavior.”

For Ammerman, that case symbolizes both the many challenges and rewards that the program presents.

“Working with the kids is of course challenging because, besides all of the normal adolescent issues, being homeless or being in poverty adds on another whole set,” he said.

Ammerman also acknowledged the difficulty for homeless and uninsured adolescents to overcome these problems themselves.

“It takes time to get motivated to change your behavior and it takes time to do it,” he said. “We’re very patient, and we know that.”

Though all patients come to the van voluntarily, the program has attempted to attract more adolescents by offering two free movie tickets for first-time visitors who get comprehensive evaluations. Ammerman noted that this is usually substantial motivation for kids who most likely can’t afford to go to the movies, and that the offer usually ends up attracting a fair number of follow-up patients.

“Once they go through the whole [evaluation], they usually come back, even if they did only come for the movie tickets,” he said.

The health van now has a follow-up rate of over 68 percent.

Ammerman hopes to expand the number of days each week that the van runs and perhaps someday, to make it a full-time operation.

“The need is certainly there to be full-time if we had the funding,” he said. “Unfortunately, the number of uninsured and homeless is increasing, and the problem’s not going away.

“Funding is a big challenge because all of our services, of course, are free,” he added. “We are almost exclusively funded from grants from foundations and philanthropic individuals.”

The van welcomes volunteers through the Lucille Packard Children’s Hospital volunteer program. Though Ammerman said that students would not directly help with the medical examinations, they would form relationships with the patients and help make a difference. Currently, no Stanford students are involved with the program.

“I feel very strongly that it’s important to serve and help kids in our community who are underserved or un-served,” he said. “We are targeting kids who wouldn’t have health care on a regular basis.”

He added: “I really feel strongly that it’s important not only to do all the high-tech care that the hospital does but that we also do the outreach into the community [for members] who are lacking even basic services.”