PALO ALTO, Calif-- Lucile Packard Children's Hospital operates the only mobile health clinic in the country that provides free, comprehensive health care exclusively to homeless or uninsured teens and young adults, the most underserved population in Santa Clara County, according to United Way needs assessments.

Started in 1996 in Santa Clara County, the Teen Van program was expanded to San Francisco in 1999. By December 2000, it had provided health care services to nearly 2,000 patients in Santa Clara County, and more than 400 in San Francisco, and its impact continues to grow.

The number of homeless and uninsured adolescents is high and increasing, said Seth Ammerman, MD, medical director of the Teen Van, and assistant clinical professor at Lucile Packard Children's Hospital. The adolescents Ammerman sees in the program often suffer significantly more from untreated or under-treated medical and psychosocial problems than adolescents who have homes and health insurance. "I'd love to be out of business," he said.

Recognized as a national model by the National Health Care for the Homeless Conference, the Teen Van focuses on prevention and early intervention. "Our goal is to diagnose and treat medical illnesses earlier rather than later so treatment is simpler and less expensive," said Ammerman, who added that for every dollar spent on the Teen Van, the program saves about four dollars in health care costs.

Before the program began, these patients received mostly episodic acute care rather than preventive care, said Ammerman. Many of them waited until they felt sick before seeking care. "That's a very poor and very expensive way to maintain health," he said.

The Teen Van also includes a pediatric nurse practitioner, a pediatric registered nurse, a nutritionist, a half-time social worker, a driver and a registrar/medical assistant. Services include medical care, gynecological care, mental health services and counseling for issues such as nutrition, substance abuse and family planning.

Comprehensive care is critical because these teens have so many interconnecting issues, said Ammerman. They suffer significantly more from untreated or under-treated medical and psychosocial problems than adolescents who have homes and health insurance. Of the patients Ammerman sees on the Teen Van, nearly 90 percent are sexually active and use one or more substances such as tobacco, alcohol or marijuana.

Funded through the Lucile Packard Foundation for Children's Health, the Teen Van goes out twice weekly: one day to Santa Clara County, the other to San Francisco. It rotates between eight sites on a regular basis, so teens know when to expect it. Almost 60 percent of patients return for follow-up care, an extraordinarily high figure for this population, said Ammerman. The single biggest source of referrals is other teens.

"Once the kids get engaged with us and start taking care of their health, you see them start to become more responsible in other areas of their life," he said. In fact, two-thirds of Teen Van patients end up off the street. "I feel like we're having an impact that's positive."

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Lucile Salter Packard Children's Hospital at Stanford is a 240-bed hospital devoted entirely to the care of children and expectant mothers that is celebrating its tenth anniversary in 2001. Providing pediatric medical and surgical services associated with Stanford University Medical Center, Packard offers patients locally, regionally and nationally with the full range of health care programs and services - from preventive and routine care to the diagnosis and treatment of serious illness and injury. To learn more about Lucile Packard Children's Hospital, please visit our Web site at www.lpch.org.