Mobile Clinic Aids Young Minnesotans

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By Miki Fairley
The Gillette Mobile Outreach Clinic keeps close track of miles saved--this information is used to help them obtain funding to keep the clinics going. Miles saved = time saved. They average about 275,000 miles saved for their clients per year. Photos courtesy of Gillette Mobil Outreach Clinic.
The Gillette Mobile Outreach Clinic keeps close track of miles saved--this information is used to help them obtain funding to keep the clinics going. Miles saved = time saved. They average about 275,000 miles saved for their clients per year. Photos courtesy of Gillette Mobil Outreach Clinic.

From this small beginning, the Gillette Children's Specialty Healthcare Outreach Clinic has grown to about 150 clinics a year, seeing about 1,700 patients, and providing about 2,000 services each year. This unique program celebrated its 20th anniversary in 2005.

Why has the program proved so successful in filling a vital need? Minnesota is a big agrarian state with relatively few large metro areas. Says Wilkie, now manager of outreach services, "Once you get out of the Twin Cities area, many people have to travel long distances to get higher-end medical care." Wilkie observes, "The whole western and northern parts of the state don't have many metro areas and the biggest ones are around 50,000 population or so." Interestingly, Minnesota is the12th largest state in land area, but only the 21st largest in population.

However, this doesn't mean that young Minnesotans with disabilities and their families must travel long distances for specialized care. Most Minnesotans are within 100 miles of the Outreach clinics, according to Wilkie, with the northernmost point being Roseau, close to the Canadian border. The drive takes about seven and a half hours one-way to hold the four clinics a year in Roseau.

The well-equipped tool carts are unstrapped and lowered to street level, then easily wheeled into clinic site.
The well-equipped tool carts are unstrapped and lowered to street level, then easily wheeled into clinic site.

The clinic travels to about 20 different cities, and can set up in hospitals, churches, schools, and even American Legion and Veterans of Foreign Wars (VFW) halls, and similar facilities. Once a clinic was even set up in a library.

Services Provided

The Outreach Clinic's caseload is mostly pediatric, although some services also are provided to adults with disabilities. Patients include those with cerebral palsy, spina bifida, and muscular dystrophy, among other conditions. The clinic's assistive technology includes custom seating and mobility devices, braces, alternative communication devices, electronic aids to daily living, and computer-access equipment.

Mobile clinic staff, depending on the needs of a particular clinic, may include a certified orthotist, speech and language pathologist, certified assistive technology practitioner, a seating specialist, rehabilitation engineer, a physical and/or occupational therapist, and a pediatric rehabilitation medicine physician. About three to five healthcare professionals participate in each clinic, depending on the particular need of that clinic, so not every specialist goes on every outreach clinic.

Clinic sites include legion halls, churches, schools, hospitals and medical clinics.
Clinic sites include legion halls, churches, schools, hospitals and medical clinics.

"Gillette follows our patients closely, so if they are here at the hospital, we often try to feed them into the outreach program so they don't have to return to the hospital for adjustments, repairs, or new orthoses," explains Wilkie. "We try to save families the wear, tear, time, and cost of trying to go to the metro area for services. With the mobile clinic, they don't have to burn up their vacation time or spend extra money on hotels, food, etc." The Mobile Clinic saves patients and families about 275,000 travel miles each year.

The program utilizes three large trucks, so more cities can be visited during the same time frame. Most trips involve one night away, but some can be up to four nights. Since the trucks are large commercial vehicles, drivers have to obey the US Department of Transportation regulations regarding driving hours during a given time period.

The clinic also provides education and training for community service providers and allows the team to consult with local community professionals to evaluate people for assistive technology devices. For instance, if a local professional wants a patient to try out a certain expensive communication system, the professional and patient can try it and obtain a baseline as to whether the device is appropriate and whether more training is needed to use it effectively. "We can then help them go through the funding process," Wilkie adds.

Telemedicine: Innovative Technology

In 2003 telemedicine was added to the Mobile Clinic's armentarium. For instance, in one town the clinic team works with the local hospital in a joint seating evaluation program. The hospital's therapists, clients, clients' families, and perhaps a DME dealer, are connected with the clinic team via the telemedicine system. The clinic's seating specialist then evaluates and designs the seating system. Once the system is approved for payment, it can then be delivered.

At first, the clinic's seating team was apprehensive about using telemedicine, Wilkie remembers. "You mean we're not going to be able to take our own measurements?" some would say.

Wilkie would explain, "You can see how the therapist is taking the measurements, and if you don't like how it is being done, just explain how you want it done and ask the therapist to please do it again." The system has been working well, so after the first couple of cases, the seating team was onboard with the technology.

Telemedicine does have some drawbacks currently, though, Wilkie added. Not every location has computer hardware that's compatible with the sophisticated system. Reimbursement for healthcare professionals also can be a problem. For instance, two physicians or two therapists might be involved, but only one can actually bill for the service. However, orthotists and seating specialists are not paid for evaluations; their time and skills are built into the cost of the product, so this is not an issue for them.

Gillette: Over 100 Years of Caring

The Mobile Outreach Clinic carries on a Gillette's Specialty Healthcare tradition begun more than 100 years ago. In 1897 a young doctor in St. Paul decided to specialize in orthopedic surgery to correct children's disabilities caused by deformities of bone and muscle. The need was so great that Arthur Gillette, MD, teamed up with Jessie Haskins, a young woman with a disability, the organization's website recounts. Together, they persuaded the Minnesota legislature to publicly fund a hospital dedicated solely to the treatment of children with disabilities. Says the website: "Gillette Children's is always changing to meet the needs of children, adolescents, and young adults, providing medical treatment and technology to care for children with disabilities and chronic conditions. Our challenge for the future and beyond is to give these people with disabilities and chronic conditions more freedom than ever before. We'll do this with the most advanced healthcare we know, and by working with families and communities so our patients can become active citizens."