Lack of transportation is one of the most common barriers to care for people with opioid use disorder (OUD).
Some providers are surmounting this problem by bringing care directly to patients.
Mobile vans are used by both nonprofit and for-profit substance use disorder (SUD) providers to target people who struggle to access treatment through traditional models. These mobile treatment clinics, which may become increasingly common across the SUD industry, can serve as a guide to improving traditional SUD treatment clinics.
Non-traditional, low-barrier treatment models are crucial to treating especially vulnerable populations, according to Deborah Agus, executive director of the nonprofit organization Behavioral Health Leadership Institute, which operates a SUD treatment van that parks outside a Baltimore jail.
“A lot of people don’t want to go to a program that requires them to go to meetings and other ancillary things that they need to do to stay in the program,” Agus told Addiction Treatment Business. “Those things are great, but for this population who’s been left out for so long, feels very marginalized, or is going in and out of jail and homeless, they just want to try treatment. And we want them to try treatment, so that’s why we’re so low-barrier.”
The Behavioral Health Leadership Institute works to improve mental health and SUD treatment delivery through workforce education, public policy initiatives and service delivery projects for people living in vulnerable and underserved communities.
The organization’s mobile unit, called the PCARE van, parks outside a jail’s release door from 7:30 a.m. to 3 p.m. five days a week, with extended hours until 7 p.m. twice a week. A group including a driver, physician and nurse, and an outreach team provide medications for opioid use disorder (MOUD), provides a form of identification and connections to other resources.
The van treats about 40 people on its shorter days, and about 60 on its longer days, Agus said.
Linking patients to care
Some mobile vans focus on treatment initiation and linkage to treatment while others are designed to provide long-term care.
The PCARE van’s goal is to transition its patients to other treatment programs after they are stable and have stayed in treatment for a length of time, though some patients have stayed in care with the PCARE van since the beginning.
The van has relationships with traditional SUD programs through the University of Maryland and works to transition patients with insurance to a program that suits them, though challenges often arise in the process.
“Transition is our biggest problem,” Agus said. “Nobody wants to take people without an ID. … When people leave jail, they do not get a picture ID, which is a huge barrier.”
To solve the ID problem, PCARE van operators use a “little pink Polaroid camera” to take a photo of patients and affix it to a card with the patient’s information. The ID is not official, but it allows patients to pick up their prescriptions, Agus said.
Even if patients have an ID, transitioning patients from vans to other forms of care is often difficult, according to Dr. Margaret Lowenstein, assistant professor at the Perelman School of Medicine at the University of Pennsylvania, and research director for the university’s Center for Addiction Medicine and Policy.
Lowenstein has witnessed high drop-out rates when transitioning patients from mobile van care to brick-and-mortar facilities.
“Our health care systems have often not only been difficult to access logistically, but have been actively stigmatizing or discriminatory towards patients, and there’s a lot of trepidation or even trauma around seeking care,” Lowenstein told ATB. “[Mobile units are] an attempt to remedy that. For some people, I think that’s just the preferable place to get their care.”
A different ethos
Along with making care more accessible, mobile units can help people feel more comfortable getting treatment when they may otherwise feel stigmatized or unwelcome in traditional modalities.
In Lowenstein’s experience, one factor that improves retention at the linkage to brick-and-mortar programs is patients being transferred to facilities staffed by some of the same clinicians who worked in the mobile van. To improve retention rates, Lowenstein recommends that brick-and-mortar facilities take a page out of mobile clinics’ books and be as flexible with patients as possible.
This flexibility could look like forgiving patients showing up late to appointments, or failing to stay abstinent but decreasing drug use while staying on medication.
While overcoming logistical hurdles like lack of IDs is one of the key benefits of mobile SUD units, another is the low-barrier, harm-reduction ethos vans often operate with.
“A lot of the focus is meeting people where they are, literally, logistically, but also doing a lot more outreach and creating sort of a safe entry point into substance use care,” Lowenstein said. “A lot of traditional models … [ask] people to meet certain expectations as a precondition of getting medication when really, medication for opioid use disorder is the treatment modality, full stop. Some of the other things can be very helpful for patients, but medication is the thing that reduces mortality.”
For-profit vs. nonprofit
There is no national data on who operates mobile vans in America, Lowenstein said, but because they can be capital intensive, they are often run by academic or nonprofit organizations.
Some for-profit organizations have also seen the benefits of SUD treatment on wheels, however.
Behavioral health care giant Acadia Acadia Healthcare (Nasdaq: ACHC) operates about 10 vans across the country in underserved markets with unmet need for addiction treatment care, according to Jacob Cooper, operations group president for Acadia Healthcare’s comprehensive treatment center (CTC) business line.
“We take a very patient-centered view to treatment, underpinned by a harm reductionist approach and meeting patients where they are, which is exactly what our mobile vans allow us to do nationwide,” Cooper told ATB. “In certain communities that are underserved, mobile vans act as essentially an extension of the existing brick-and-mortar locations and allow additional patients to receive treatment close to home.”
Franklin, Tennessee-based Acadia operates 258 behavioral healthcare facilities with approximately 11,400 beds, as of June 30, 2024. It has placed significant focus on its opioid treatment program (OTP) business, which it calls CTCs.
Acadia’s vans are each organized under an existing brick-and-mortar facility and typically have a single location where they park during the day, and then return to the facility at night. The provider has partnerships with jails and correctional facilities, skilled nursing facilities and other community organizations to bring all the same services it can provide at its brick-and-mortar facilities directly to patients.
While difficult to estimate an exact number of patients served, Cooper said it is reasonable for a van to have a treatment panel of up to 100 patients.
Unlike the PCARE van, Acadia’s mobile units are designed to keep patients in long-term care.
“I think having consistency and stability in accessing treatment is like the most important thing for them, ultimately, to go into this life-saving treatment and improve their lives,” Cooper said. “Having a single consistent place where they know if they go to show up [where] there will be treatment access for them is actually better.”
The future of mobile SUD options
Mobile units’ capabilities were cemented earlier this year, potentially setting the stage for increases in the modality.
The U.S. Department of Health and Human Services (HSS) released a final rule in February that made permanent comprehensive services in mobile units and encouraged opioid treatment programs (OTPs) to apply for grants to open more mobile units.
Acadia is also “constantly” looking to expand its mobile van program, Cooper said.
“There’s unmet need for treatment out there, need for [medication assisted treatment ](MAT) services, Acadia’s services, and we view mobile vans definitely as a key piece of a way to expand access to that care,” Cooper said.
He predicts that mobile vans will become more common now that new federal regulations take a more progressive approach to care.
Lowenstein anticipates that excitement around non-traditional care delivery models will continue.
“I don’t know that this is ever going to be the way that most people access substance use care, but I think for a slice of the population, these are really promising,” she said. “Not every clinic is going to have a mobile van. Not every clinic is going to do street medicine, but there are things that we can learn from those models that clearly are attractive to patients.”
Companies featured in this article:
Acadia Healthcare, The Behavioral Health Leadership Institute
