By GRACE HAMMERSTROM

Most of his patients suffer from multiple medical, psycho-social and developmental issues. Many are homeless or uninsured. And many abuse substances and are sexually active. The thing they all have in common, however, is that they're teens.

And that's just how Seth Ammerman, MD, likes it. Ammerman, medical director of the a program called Teen Van, and assistant clinical professor at Lucile Packard Children's Hospital, genuinely likes teenagers, a rare quality that has shaped his career.

From an early age, Ammerman was involved in community service. As a teenager himself, he volunteered for the War on Rats in Washington, visiting inner-city areas to educate people about reducing rat population. His father,a neurosurgeon, brought him to the hospital, which sparked a life-long interest in medicine.

"It's not surprising that I chose medicine," said Ammerman. And it's not surprising given his background, that most of his work involves community medicine. After coming to Stanford as an adolescent medicine specialist in 1991, he jumped at the chance to expand the Pediatric Van program to cover adolescents.

"I knew there was a large, unmet need out there," said Ammerman. A United Way needs assessment showed that homeless and uninsured teens and young adults are the most underserved population in Santa Clara County. Under Ammerman's direction, Packard began operating the Teen Van, the only mobile medical clinic in the country that provides comprehensive health care exclusively for teens.

Started in September 1996 in Santa Clara County, the program was expanded to San Francisco in 1999. By December 2000, the Teen Van had provided health care services to 1,847 patients in Santa Clara County, and 422 in San Francisco.

"I'd love to be out of business," said Ammerman, but the number of homeless and uninsured adolescents is increasing.

These adolescents suffer significantly more from untreated or under-treated medical and psychosocial problems than adolescents who have homes and health insurance. That's why the van's focus is on prevention and early intervention. Services include medical care, gynecological care, mental health services and counseling for nutrition, substance abuse and family planning.


The kids who visit Packard's Teen Van are among the most
underserved population in the Bay Area. Through positive word of mouth, the van has become a health services fixture in the
community.

"Our goal is to diagnose and treat medical illnesses earlier rather than later so treatment is simpler and less expensive," said Ammerman. "It is conservatively estimated that our services result in health care cost savings of $1.6 million a year in early treatment or prevention of illnesses." That means for every dollar spent on the Teen Van, the program saves approximately four dollars in health care costs. The Van's biggest asset, however, is that it's teen friendly. Every member of the staff enjoys working with teens, said Ammerman. Almost 60 percent of patients return for follow-up care, many referred by their peers.

From his earliest experiences in medical school at George Washington University in Washington, Ammerman has been a natural at working with adolescents. He completed his residency in pediatrics at the University of Michigan at Ann Arbor, and joined the Public Health Service's Rural Health Service program as payback for a government-funded student loan. That experience took him to Price, Utah, where he was one of the only pediatricians in the southern half of the state.

Ammerman then headed to San Francisco. He joined Mt. Zion Hospital, attending in the teen clinic, which served inner-city kids. He also worked part time at Juvenile Hall in San Jose. His interest in teens persuaded him to do something uncharacteristic for the average physician. He became an adolescent medicine fellow at UCSF Medical Center, taking a cut in pay and going back to being a student. After two years, he completed his fellowship, and began working in the Mission Neighborhood Health Center in San Francisco, where he continues to deliver health care to mostly Spanish-speaking teens.

When you see Ammerman in action, it's obvious that his patients feel comfortable with his easy-going nature. "Once the kids get engaged with us and start taking care of their health, you see them start to become more responsible in other areas of their life," he said. In fact, two-thirds of Teen Van patients end up off the street, he said. "I feel like we're having an impact that's positive."