Mobile clinics offer model of health care that treats patients where they are

When a stroke forced her mother to move into an assisted care facility, Karen Belanger knew she needed to find a way for her to receive a COVID vaccination there.
Peggy Ruble.
She learned that Disability Rights Michigan (DRM) organizes mobile clinics around the state to reach people who can’t get to a medical office or a pharmacy for a COVID vaccination or booster.

At her request, DRM organized an on-site vaccine clinic in the Fall of 2022 at the assisted living facility where Belanger’s mother, Peggy Ruble, lived. The clinic provided seven COVID-19 vaccines and 20 flu shots that day for people in the facility. While nursing homes often provide vaccinations, that isn’t the case with assisted living facilities. 

Mobile clinics offer a model of health care for people who face barriers to accessing care. This on-demand service helps seniors and people with disabilities to get vaccines and other care. 

“It’s an extremely helpful service because my mom had a lot of mobility issues,” Belanger says. “At 93 years old, it would have been difficult for her to leave assisted living to go to get a shot. After suffering a stroke a year earlier, it was extraordinarily difficult to get in and out of a vehicle  and walk into a doctor’s office or a pharmacy, so it was just wonderful that somebody came to her and did it and then offered it to the other residents.”

Belanger knew the benefit of the vaccines because when her mother had COVID a year earlier, her case was mild because she had been vaccinated. Belanger noted that while her mother died in October, she had a healthy last few years because vaccinations protected her from getting seriously ill. 

“This service should be kept going and should be expanded,” she said.

Mobile clinics lift a barrier

Transportation has been a barrier to accessing health care, particularly for those with disabilities, says Sharon Milberger, director of the Michigan Developmental Disabilities Institute (MI-DDI) at Wayne State University in Detroit. The situation was worse during COVID-19 when people with disabilities were more isolated, 

“We're working with mobile units to combat health disparities for people with disabilities,” says Milberger. “We're bringing services to where people are, whether that's at a community-based event or whether it's taking the service into someone's home. We’re reaching those hardest-to-reach people who are homebound or might be in a shelter.”

Jaime Junior at an event where MVP/Wayne Health Mobile was present.
Along with Disability Rights Michigan and Autism Alliance of Michigan, MI-DDI helped create the MVP (Most Valuable Provider) certification, a model Milberger uses to advance health equity for people with disabilities. 

One example of mobile clinics is the Wayne Health Mobile Unit (WHMU). It has a fleet of eight medically equipped vans, one of which is ADA-compliant. The WHMU is staffed by registered nurses, medical/research assistants, community health workers, and patient and family health advocates and overseen by physicians from the Center of Population Health and Accountability at Wayne Health. The team offers a variety of free health screenings and services to its patients.

Milberger said there are now 23 MVP-certified sites across Michigan, including three mobile units: WHMUDocGo, and Recovery Mobile Clinic. There are other mobile clinics across the state, including some operated by county health departments.

“Wayne Health Mobile Unit was the first to become MVP certified and has been one of our strongest clinical champions,” Milberger says. 

Four keys to MVP status 

Milberger says the MVP certification process addresses health inequities in four ways. The first is by addressing bias in health care.  

“Some health care providers make assumptions that people with disabilities have a low quality of life or aren’t competent to make their own decisions,” says Milberger. “There's a lot of attitudinal barriers that they experience.”

To combat that bias, MI-DDI requires disability awareness training, with a free 90-minute online session, for MVP certification. 

“Any of the mobile units that are part of our program, their entire staff has gone through this training. It talks about communication techniques, intersectionality, and how to prevent ableism,” says Milberger. 

The Wayne Health Mobile Unit with (L-R) Patti Ramos, Kristen Milefchik, Sharon Milberger, and Dr. Rhonda Dailey.
A second issue is accessibility. 

“With our MVP-certified sites that are actual physical sites that don't move, we make sure that they are physically accessible, meaning if there are stairs to the building, that there's a ramp. If there's multiple floors, there's a working elevator,” Milberger says. “When a vehicle itself is not accessible, services can still be provided to someone who uses a wheelchair while in their chair.”

The third requirement is that the site is sensory-friendly. That involves a consultation with the Autism Alliance of Michigan to make sure sensory barriers like noise, lighting, and smells are taken into account. MI-DDI offers resources to create a more soothing environment for those with sensory needs. 

The Wayne Health Mobile Unit at an MVP event.
Finally, all the MVP-certified mobile clinics collect data about disability status and accommodation needs, along with the usual data such as age, gender, and race.

“If we're trying to show how health disparities are being addressed, it's really hard to do that without having numbers to show that,” Milberger says. “There's a saying that we measure what we treasure.” 

Once these four criteria are met, the mobile units receive a designation with a shield indicating that it is MVP certified.

“If you want to show how you're addressing disparities and inequities related to vaccines, you cannot do that if you don't keep track of disability status,” says Milberger. “Our goal is that disability status be included in the state's dashboard, and that would be routinely collected data like any socio-demographic variable such as age, race, and sex instead of it being an afterthought, which is so much harder to measure. 

“We are making great strides, but we're just beginning, and we have to keep working at really elevating disability status so it's on people's radar.”

Mobile clinic a ‘game changer’

Disability advocate Jaime Junior has helped organize two health fairs that brought in the ADA-compliant Wayne Health mobile clinic.
Jamie Junior.
“It’s a game changer for folks who are not always able to access traditional health care. I use a wheelchair myself for mobility, so sometimes going to a traditional clinic is not possible,” says Junior, who says her disability is cerebral palsy, which has been progressive. She began using a wheelchair eight years ago.

“This vehicle takes it to a whole new level. I like to call it a universal welcome. I'm a huge proponent of a three- or four-dimensional approach to accessibility. That includes belongingness. Imagine going to just a traditional resource health fair with your family and being able to utilize the same type of equipment they use. You're not feeling ostracized, you're not feeling put aside, you're not feeling like you're not part of the group.”

Junior is vice chair of the Michigan Developmental Disabilities Council. Each state has a council that’s part of the national network. Federally funded, the self-governing organizations are charged with identifying the most pressing needs of people with developmental disabilities in their state or territory.

She previously worked with Disability Network Wayne County Detroit as an educator and accessibility specialist and is working for Detroit’s People Platform as a temporary canvasser on the transit justice team while completing her bachelor's degree in communication with a focus on health care. 

She received her COVID booster at an Arc Detroit health fair near her home in Detroit’s Brightmoor neighborhood. 

“I like that the DRM vaccine initiative is creating a tailored experience for individuals with disabilities to feel comfortable,” Junior says. “There’s not enough physical environments that are accessible to them.”

Shandra Martinez is the lead writer for the Disability Inclusion series. She’s also the managing editor of The Lakeshore and Rapid Growth.

Photos of Jamie Junor, Karen Belanger and Sharon Milberger.

Disability Inclusion is a series exploring the state of Michigan’s growing disability community. It is made possible through a partnership with Disability Rights Michigan.
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