Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.

I met Jennifer Hammonds when I was in high school in West Frankfort, Illinois, through her work on the “Care-A-Van” – a school health clinic on wheels that serves a few high schools in the rural southern part of the state, including my alma mater. This is definitely not an unbiased interview, as one of my nerdiest activities back then was decking the Van out for the annual Lights Parade and otherwise brainstorming ways to generate community support for its mission. But I think learning a little more about how mobile health care can work in small towns is valuable, whether you should trust my take on it or not.

Enjoy our conversation about funding battles, the pandemic’s effects on issues mental and material, and the overlooked importance of high quality adolescent healthcare, below.

The Southern Illinois University’s “Care-A-Van” is a medical clinic on wheels. (Photo courtesy of Jennifer Hammonds.)

Olivia Weeks, The Daily Yonder: Let’s just start with the history of the Care-A-Van, and what exactly it is. Is this a common model for rural health care? Where did the idea for healthcare on wheels come from?

Jennifer Hammonds: So it started about 16 years ago when our residency program director for Southern Illinois University School of Medicine’s Family Medicine here in the Carbondale area, Dr. Penny Tippy, who was from West Frankfort – both of her sons went to West Frankfort High School – recognized that the adolescents in Franklin County did not have immediate access to mental health care, or acute medical care. The state of Illinois allows for some medical and counseling and substance abuse treatment to occur without parent or guardian consent, and there was just no place for kids to access those things if they didn’t have parent or guardian support. So the idea of a Care-A-Van as a school-based health center was born out of that thought process, because school-based health centers were being developed around the coastal cities, but weren’t common in the Midwest. And so Dr. Tippy, along with the planning committee, decided that using a mobile unit would allow us to serve more schools in Franklin County, instead of just one, which would be really advantageous. And so, from my understanding – I started on the van about a year after it was created — they began by applying for funding not only from the Illinois Department of Public Health, but also the Illinois Children’s Health Care Foundation. And I believe there was some federal funding as well because the van itself was about a million dollars to build, so it was quite a big investment in the community for the medical school.

They began with Frankfort and Benton High School, and the Care-A-Van operated five days a week with a physician’s assistant, a registered nurse, and a licensed clinical social worker (LCSW). When it started it was marketed really well, so when I came on a year later as the new LCSW it was a very busy, active school based health center. And at the time, we  were the only mobile certified school based health center in the state. Since that time, there have been a lot of other mobile units developed like dental vans, or you might see dialysis vans, different mobile medical units have really kind of taken off. But we’re still unique in that we are certified by the Illinois Department of Public Health.

DY: Gotcha, so at this point you’re telling a story about a very successful project –  it was very busy on the van and very well marketed. I’m curious about how that changed over time and where you’re at now in terms of what the van offers to the schools you guys still serve.

JH: I think in the beginning there was an understanding that we were there to be helpful, for instance, to parents or guardians that were working full time and couldn’t leave work to take their kids to see the doctor when they had a sore throat or an earache or something at school. This was a convenient care option that the school staff members used well. Having counseling full time, which is still not very common in school based health centers in general, was a big deal. We were really seen as being beneficial for the students in reducing absenteeism, and it felt like everyone agreed that healthy kids equal healthy academics equal healthy communities. But then where we had some change at some point was the recognition that students could receive what we refer to colloquially as confidential services like pregnancy testing, STI testing, and contraception. For a period of time, there was some concern within the community about those services. We really had to work at educating the schools and the communities about what comprehensive adolescent health care means using data from the Illinois Youth Survey and the Illinois County Health Rankings to talk about data on teen pregnancy, disease transmission, obesity, smoking, drug and alcohol use rates, and things like that. Gradually we began to really, I think, create an even more robust understanding within the community of what the Care-A-Van really offers.

DY: So, in concrete terms, what do you guys do today?

JH: Today we are well utilized at the schools that we’re at, and I honestly wish we could still operate five days a week because we’re not able to hit every school that has reached out and wanted us to be present for them. But at the schools we serve, students and staff have really relied on us being around post-pandemic. The mental health need is quite substantial for students that are coming back to a full time school situation because maybe they have social anxiety after being at home, or maybe home might not have been safe or consistent throughout the pandemic. And so we’re seeing more trauma reactions, a lot of depression and anxiety. And that relates to what we’re seeing with more drug use and more housing instability, and a lot more physical complaints. All these things seem to be tied together.

DY: I know that you have faced a lot of challenges throughout your years working for the Care-A-Van in terms of rural-urban difference, and difficulties with funding mechanisms given that you guys serve a relatively small population compared to other school-based health centers. Can you speak to the questions you might get about what the particularities of rural school healthcare are, and why the Van is necessary, even though it may only serve a relatively small population?

Jennifer Hammonds works as an LCSW on the van. (Photo courtesy of Hammonds.)

JH: We’ve been told by the Illinois Department of Public Health that our funding grant is going to become “more competitive” based on certain data like utilization rates and the outcomes we can measure, so there is some concern among the rural school health centers – and there aren’t many of us south of Springfield – that it is really hard to compare our utilization rates in small rural communities to those of say Cook County Schools. In the northern part of the state that tends to be more urbanized, they utilize really amazing brick-and-mortar style school health centers within the school building. So students can get a pass to go to the office and go to a wing of their high school that has a functioning clinic.

Those health centers can see community members, not just students, and they can have wellness nights, open houses, and students can come in and decorate and paint the walls. They can be really well integrated into the school building because they’re right there. We don’t have that because we’re more spread out here. We’re less densely populated and though some adolescent health needs are universal, we can’t ignore that each area within the state has its own specific issues. Here, we’re combating a lot of teen homelessness and teen methamphetamine use. So the comparison between, if we see 20 kids that day and the schools that are in Chicago and its collar counties see 200, we want to make sure that the value of both are recognized. Our students really benefit from having this kind of comprehensive health and medical care because they may not get it otherwise, especially when we’re talking about the amount of students that are being identified as homeless currently, who don’t necessarily have a parent or guardian there to consent for them to go to the doctor or to assist them in getting the services that they need. So being able to be on campus and working within state and federal law to provide those kids services above and beyond what they could get in normal circumstances is really important to us.

DY: I know that, in addition to the work you do with students at the school, you’ve been involved in a lot of community engagement efforts over the years. I’m hoping you can talk to me about why that’s important, and the role that those broader community engagement efforts have for the Care-A-Van right now.

JH: It’s not enough to just be in the Van and be a provider. We need to be visible in community groups to show that we are invested in the community because those things really correlate with what the mission of the Medical School and the Care-A-Van is, which is to provide teen-friendly rural health care that’s specific to this particular culture and population. So I think it’s imperative for school health centers and people that work with adolescents to be aware of what is going on in our local communities because your mindset can get too narrow. In Illinois, for example, heating costs have gone through the roof and our local energy assistance is out of funding until January. So we’re looking at many, many, many families who may not be able to afford to heat their homes this winter, and then come January, there will still be limited funds to access. That issue, which is really important we’re aware of, has come up in a lot of the community groups we’re involved with. We’ve also had quite a bit of a housing crisis in our area. There seems to be less and less availability, so we’re finding a lot more kids being shifted around to staying with family friends, or they’re staying with friends from school, or in hotel rooms. We’ve also had a significant increase in the adult homeless population in the Franklin County area, so it’s all been really daunting since the pandemic and as we’re kind of trying to return to a normal.

DY: I feel like that’s something that always comes up in trying to talk about rural health care in general, is that you’re trying to balance the individual help, like, “I can see that you have this need and this service provider can help you meet that need,” against the cause of that need, which is often so much more structural in nature, and so much bigger than what’s going on in any individual family.

JH: Yes and it’s frustrating, I think, for those of us who work directly with families because there’s only so much we can do. You really have to advocate to have system change, and advocate politically to highlight the struggles that our families and kids are facing. And I say this all the time but I think when we talk about childhood health care, we think about how young kids and adolescents are often really overlooked in a time when their health care and mental health care needs are really potent. Adolescents carry a lot of stress, they’re under a lot of pressure. A lot of them are taking on adult roles in their families, either helping financially or taking care of younger kids in the family. It’s just a lot and so being there one-on-one for them, but also looking at things on a mezzo and macro level, is really essential for the health of our communities.

This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.

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