The Project HEALTH, "Family Help Desk" Program targets a dual audience: 1.) undergraduate college students; and 2.) children, adolescents, pregnant women and adults receiving health care at a pediatric clinic, public health clinics, substance abuse treatment centers, mobile needle-exchange program and a community health center.
The goal of Project HEALTH is to mobilize college students to combat public health issues in Baltimore City and improve health outcomes for Baltimore city residents. This is achieved through three objectives:
Implement four (4) Family Help Desk programs in unique settings across Baltimore City to assist 1500 individuals annually in accessing community resources.
Establish a comprehensive community resource database hosted on a publicly available website, www.cap4kids.org/baltimore.
Successfully mobilize college students to combat the socio-economic disparities of Baltimore City residents that result in poor health outcomes.
Baltimore City ranks near the bottom in nearly all health and socio-economic indicators for metropolitan cities in the United States. Roughly one-third of children and adults in Baltimore City live in poverty (US Census Bureau, 2004). Infant mortality rates are nearly twice the national average (Maryland Department of Health and Mental Hygiene, 2005) and Baltimore/Towson Metro has the second highest AIDS rate per capita in the country (CDC, 2005). These factors are compounded by the cities other issues - including unemployment rates nearly twice the national average (Bureau of Labor Statistics, 2006), the third highest violent crime rate in the country (FBI national report, 2006) and a substance abuse problem that the National Institute on Drug Abuse cited as one of the most prevalent in the United States.
Literature has shown that public health interventions such as increasing literacy, increasing access to health care and increasing food security can improve health outcomes for children and adults. Project HEALTH utilizes a patients visit to a clinic, hospital or other public health setting as away to address these issues. By broadening the practice of healthcare to address social determinants of health, Project HEALTH seeks to transform the healthcare sector. The Family Help Desk program empowers low-income families by providing the resources, skills & knowledge to take control of their health. The Family Help Desk engages physicians to act as catalysts to address the social needs of patients, and serves as the infrastructure to assist patients when a need is identified. Utilizing a method of undergraduate volunteer mobilization and clinic-based resource and advocacy programs, Project HEALTH works with hospitals, universities, and community partners to motivate young people around issues affecting health care and break the link between poverty and poor health in Baltimore City.
The Baltimore City Health Department in conjunction with Baltimore HealthCare Access mobilizes college students to connect individuals and families with critical resources to live stable, healthier lives. In 1994, The American Academy of Pediatrics (AAP) recognized psychosocial problems as the new morbidities that place families' and children's health at risk. The AAP task force recommended the screening, assessment, and referral of parents for physical, emotional, or social problems. An internal study by The Johns Hopkins General Pediatric and Adolescent Department found 70% of families surveyed want to use a visit to the clinic as a way to address their social needs. However, the majority of Johns Hopkins residents surveyed (69%) do not screen families for social problems such as unemployment, housing issues and food insecurity. The Project HEALTH Family Help Desk empowers physicians and other clinic staff to address social issues with their patients by providing the infrastructure to assist families in need. The Family Help Desk then informs those clinic providers of the resources provided to their patients and encourages clinic staff to search resources on their own by establishing and updating a publicly available community resource database.
This model serves the roles of educating young people around healthcare and social issues, engaging physicians and healthcare providers to act as catalysts, and ultimately improving the health outcomes of underserved populations. Project HEALTH has developed programs that have been situated in pediatric clinics, OB-GYN clinics, labor and delivery facilities and adolescent centers. In conjunction with the Baltimore City Health Department, the Project HEALTH Family Help Desk will be implemented on a city-wide scale to address the public health needs specific to Baltimore residents. Project HEALTH Baltimore has expanded the services of the Help Desk to new populations in new settings, demonstrating the replicable nature of the model.
Agency Community RolesIn December 2005, Dr. Joshua Sharfstein became Health Commissioner of Baltimore City. One of his first assignments was to respond to a group of college students who were arrested for providing food to homeless people at a local farmer’s market. This incident sparked the idea of mobilizing Baltimore’s college students to address proactively the City’s severe health problems. Instead of creating a new program, Dr. Sharfstein reached out to Project HEALTH, due to its successful track record of mobilizing students to meet the needs of low-income populations.
In Spring 2006, the Baltimore City Health Department joined with Baltimore HealthCare Access, Inc. (BHCA), a quasi-public division of the Health Department, to bring Project HEALTH to Baltimore. BHCA, Project HEALTH, and Dr. Sharfstein successfully invited four area foundations – including the Open Society Institute, Abell Foundation, Strauss Foundation, and Stulman Foundation - to fund a two-year pilot project to establish Project HEALTH in Baltimore.
The Baltimore City Health Department and BHCA established the first meetings with university and hospital officials, and have continually engaged those constituents in this program. The Health Department has collaborated with clinics, medical centers, and substance abuse treatment sites to work with the Family Help Desk students to sustain the programs after the two-year period. The Health Commissioner has been a guest speaker at Project HEALTH recruitment sessions on campus and other Health Department officials have played a key role in publicity events and promoting the program around the city. The Health Department and BHCA will continue to collaborate with community partners to oversee the expansion of this program into other sites.
Costs and ExpendituresFunding sources include four Baltimore area foundations: The Abell Foundation, The Straus Foundation, The Open Society Institute, and The Leonard & Helen R. Stulman Foundation. Program costs include: $250,000 for 2 years. The program is self-sustaining thereafter as each site will agree to maintain its share of the on-going administrative overhead costs as a condition of participation.
ImplementationThe implementation schedule follows:
Month 1: Hire Project HEALTH Site Director; Make community contacts to familiarize Site Director with organizations and programs in the city; - Begin compiling list of community resources and programs.
Month 2: Continue to compile list of community resources and programs; Make contacts at university, establish faculty mentor; Work with faculty mentor to identify initial student leaders who will assist in the recruitment and implementation of the program; Make contacts at site of first Family Help Desk program, establish program mentor.
Month 3: Continue to compile list of community resources and programs with student assistance; Begin recruitment process with faculty mentor and student leaders - information sessions, applications, interviews; In collaboration with student leaders, community partners, clinic staff and program mentors, conduct student training.
Month 4: Establish community resource database; Work with clinic partners and student leaders to logistically coordinate the program set-up; First Family Help Desk operational; Begin weekly student Reflection Sessions.
Month 5: On-site logistical support as needed; Bi-weekly meetings with program mentors and student leaders to discuss clinic integration, strategies for improving desk functionality, student-staff relationship, etc…
Month 6: Begin Identification of additional Family Help Desk sites; Establish contacts and program mentors at additional sites.
Month 7: Spring Recruitment process with faculty mentors and student leaders; Conduct student training.
Month 8: Logistically set-up new sites; New Family Help Desk's are operational; Begin weekly Reflection Sessions.
Month 9: On-site logistical support as needed; Bi-weekly meetings with program mentors and student leaders to discuss clinic integration, strategies for improving desk functionality, student-staff relationship, etc…
Month 10: Begin identification of additional Family Help Desk sites; Establish contacts and program mentors at additional sites.
Month 11: Summer Recruitment.
Objective 1: Implementation of the Family Help Desk program.
25% of clients seen at the desk will be referrals from clinic staff.
Assist 70 clients (10 clients/week) by the end of the first semester.
Identify 100 needs presented by clients at the desk by the end of the first semester.
Each client will receive at least three follow-up phone calls by volunteers.
50% of clients who presented housing needs received services.
50% of clients who presented job training/employment/adult education needs received services.
50% of clients who presented child care/ afterschool program needs received services.
50% of clients who presented health insurance needs received services.
50% of clients who presented food needs received services.
50% of clients who presented public benefit needs received services.
50% of clients who presented utilities needs received services.
50% of clients who presented commodities needs received services.
50% of clients who presented special education needs received services.
50% of clients who presented other needs received services.
Outcomes: The recorded data is a positive indicator to the eventual improvement in health outcomes for individuals and families. Clients are utlizing the services provided and clinicians are effectively discussing social issues with their patients and referring them to the program. Low Data results on issues such as housing and health insurance can be used as advocacy data to key stakeholders. With the Family Help Desk now well integrated into the clinic, the team of research specialists are set to conduct long-term analysis of improvements in health outcomes for individuals seen by the program.
Objective 2: Develop community resource database (CAP4Kids).
Website will receive at least 1,000 hits/ week four months after going public.
By the end of four months, the website will have at least 20 people signed up the list -serv.
At least one student will manage and upkeep the website on a bi-weekly basis.
Outcomes: The large number of hits to the website indicate that clinical providers are using the website for addressing the needs of patients and patients are using the website to find services for themselves. This dual outcome leads to greater knowledge about local resources and will benefit the entire community population.
Objective 3: Mobilization of college students/ inspiring students to careers in service.
Recruit a minimum of 10 students to volunteer for the Fall semester.
Each students spends at least 6 hours attending training sessions.
Students volunteer for at least 2 hours/week at their shift on site.
Students follow-up with clients at least 1 hour/week.
Students attend at least 1 hour of Reflections Sessions/week.
Student satisfaction survey is at least 4/5.
Outcomes: The outcome was that students were engaged and actively participated in the program. Student expressed more of a desire work with underserved populations since being involved in the program and felt a sense of ownership over the program. A student tracking system has been put in place to monitor the eventual career path of these students.
SustainabilityProject HEALTH in Baltimore will be self-sustaining after two years. Each Project HEALTH site will agree to maintain it's share of the ongoing administrative overhead (estimated at about $10,000 - $20,000 per site per year) as a condition of participation. The two-year start-up finances will provide salary support, technical support and supplies allowing Project HEALTH to establish Family Help Desk programs in the different clinic settings. As successive waves of motivated, idealistic undergraduates arrive on campus each year, Project HEALTH has an inherently sustainable pool of resources to select from and develop into student leaders who are passionate about social justice and who want to change the community in which they live.
Lessons LearnedLessons learned include:Valuable lessons were learned about the shortage of affordable housing and affordable health insurance in Baltimore City. Barriers to accessing those resources include - long public housing wait lists or wait lists closed, expensive market-value housing options, and eligibility criteria too low for health insurance. Students are addressing those issues by working with advocacy groups and public agencies to develop side projects around affordable housing and health insurance eligibility expansion. Valuable lessons were learned about clinic integration strategies, provider referral mechanisms, logistics, and follow-up protocol.
In order to facilitate a more efficient client interaction, clients were given paper information forms to fill out while students searched for resources. Survey questions were given to clients to make sure all possible issues were identified and recorded. A system of clients leaving their information in a locked drop-box at the desk allowed for clients to receive the programs services even if students were not on shift. Future modifications include developing resource books to be incorporated into every exam room in the clinic.
The website, www.cap4kids.org/baltimore, was a quick and easy way to inform students, clinic partners and community members of available resources in the city and it engages clinicians to inform themselves about community resources and address those issues with their patients. The program was able to modify the other resource tools the website offers such as template letters for Individualized Education Programs and public benefit eligibility determination databases.
Lessons were learned about which recruitment strategies made the majority of students apply to the program and how much time students can spend a week volunteer for Project HEALTH. Modifications were made to the training cirriculum with an emphasis more towards client interactions and away from too much technical information. We plan on increasing the amount of time students will be on shift per week by 30 minutes at their request to see more clients.