Phoenix, Arizona is a city of 517 square miles and stretching 67 miles across. With a city population of around 1.5 million people and a Metropolitan Area containing 4.5 million people, Phoenix is the 6th most populous city in the United States of America.
Over 8000 children and young people aged 14-24 years are homeless in Phoenix each year. Regardless of the demographics of these individuals all of them are at increased risk of illness (both physical and mental), injuries, exploitation, sexual exploitation, trafficking and all other forms of abuse. Most of them lack health insurance and don’t have access to appropriate health care.
In 2000, an innovative partnership was formed between Phoenix Children’s Hospital, Children’s Health Fund and HomeBase Youth Services resulting in the Crews’n Healthmobile, a 35-foot Mobile Medical Unit (MMU) that brought free, comprehensive medical help directly to this special population living in Phoenix.
In October 2007, the Crews’n Healthmobile II hit the streets. This 38-foot MMU has three examination rooms and the latest technology to be able to provide point of care testing and link to the individual electronic patient record.
100% of the children and young people living on the streets of Phoenix are below the Federal poverty line. It is all too common for them to pay for food or a place to stay with sex as this may be the only ‘resource’ this incredibly vulnerable group of people have available to them. The Crews’n Healthmobile is a fantastic non-judgmental resource which takes free and comprehensive healthcare directly to the children and young people in whichever area of the city they may currently be in.
In addition to the mobile unit, Crews’n staff manage the UMOM Wellness Center on the campus of UMOM New Day Family Shelter. This shelter accepts people in family units of whatever they consider their family to be. The Center is non-judgmental and does not discriminate against people because of the family situation that they are living in. A significant number of the people using this service have substance misuse problems, have limited, if any, financial resources and many have escaped from violent and abusive relationships. At any one time there can be up to 500 children staying overnight in this shelter and the staff have a key role in helping to protect those vulnerable young people from abuse.
20% of the adolescents in the shelter programme hear voices and at least 40% of the girls have been sexually abused prior to coming there.
Working with families ‘on the edge’ means that professionals could be in a situation where a Child Protective Services referral could be warranted on an incredibly frequent basis but because the system is overwhelmed, because they need to maintain a working relationship with the families they are there to protect, support and re-integrate, and because these professionals may be the only stability that a family, parent or young person has, the staff are continually advancing their education, skills and knowledge so that they can provide immediate help to families in crisis to de-escalate incredibly volatile situations to ensure the protection of children and to help ensure that the healthcare needs of all members of the family are assessed and addressed with a friendly and welcoming approach.
Many of the families are living in a continual state of crisis, at least during the early stages following arrival at the shelter. They live in concrete worlds with no ‘sugar coating’ and the staff have to be realistic, pragmatic and clear with them. Many of them have so many people already trying to input into their lives that they don’t know if they are ‘coming or going’. If they don’t even know where dinner is coming from that night, or even if there will be a dinner that night, it is no wonder that they find it difficult to engage with a plurality of services many of which, not least the health insurance sector, can be difficult, or impossible, to understand.
The dedication and expertise of the Crews’n staff is amazing and their collective passion to do the best they can, and to provide the highest quality of care, for the children and families they interact with, regardless of what the ‘rules or regulations’ might try to prevent, hamper or interfere with, is outstanding and they are a clear beacon of good practice in holistic healthcare. The staff I met have clear tenacity to succeed whatever barriers may be placed in their way and there are lessons for all of us in the way that they conduct themselves and the way that they stay enthusiastic and dedicated despite significantly challenging working conditions.
If the city of Phoenix were to be overlaid across the North of England, the diameter at its widest part would stretch almost from Liverpool to Leeds. The need for a mobile health unit, such as the Crews’n Healthmobile, is clear in Phoenix not just because of the geography of the city but because of the socio-economic status of many people living within it, including those who are homeless, and the difficulties many people face accessing reliable public transport to get them to and from locations where their health needs can be cared for.
The sheer size of the Crews’n Healthmobile would make it difficult to manoeuvre around many UK cities but there are parallels than can be drawn from the fantastic service that the Crews’n staff provide to the children, young people and families in Phoenix, and the kind of exemplary service that children and families deserve to receive in the UK and it has made me think about how (or if) people living in very rural areas, away from metropolitan hubs, access the same high standard of care that others have available:
- Those people that cannot access services distant from where they are situated should, wherever possible, have services provided to them at a location they can access even if that means breaking down traditional or long-standing barriers between different parts of the health sector or the interaction between health and social care
- Those people who may not have English as their first language, or who may not understand the intricacies of the UK health service should be guided through the processes to help them to get the best possible care from the services they access.
- Healthcare staff are not immigration police and should not be expected, or required, to place someone’s immigration status above urgent and emergency healthcare needs
- Clinicians seeing children and young people should, where appropriate, consider incorporating the HEADSSS questions into routine assessments and signposting or providing any services which the young person may need as a result of the answers to those questions
- Families, children and young people with complex and multiple needs, be they health, social care or a mixture of both, need one lead person to advocate on their behalf and to simplify and streamline the services offered and provided
This has been an incredibly action packed week and I’ve met a fantastic group of doctors, nurses, forensic interviewers, social workers and research staff. The services and projects I have been taken to and shown around with extreme enthusiasm by the staff working there were not necessarily ones that I ever thought that I would be visiting before I came to Phoenix but they have provided further evidence to me that there are some clear trends emerging about the children who are at risk of abuse in the two southern States that I have visited and there are some clear lessons that we can learn and build upon back in the UK.
Tomorrow is my last day in Arizona before I move on to Pennsylvania and the sunset this evening, having climbed 2608 feet to the top, was stunning from Piestewa Peak:
I leave the south of the United States tomorrow with enthusiasm and intrigue to see what the next week in the North East of the country will hold and with grateful thanks to everyone who has made this second week in Arizona so worthwhile.