Interviews for Medinnovation Blog - #1: Closing The Gap between Poverty and Poor Health

Key words - Poverty, Poor Outcomes, Children, Student volunteers, Peace Corps

An Interview with Rebecca Onie, Founder and CEO of Project Health

If you believe you have something innovative to contribute to improve the health system and if you would like to have your print interview appear in this blog, call me at 860-395-1501 or email me at rreece1500@aol.com to learn how to qualify for the interview and what the interview entails.

You will have my permission to use the interview as you see fit.

You may be unaware that over the years, I have conducted over 300 interviews with leading health care thought leaders. Forty two of these interviews formed the basis of my 2005 book Voices of Health Reform, and twelve interviews are now appearing in www.modernmedicine.com.

Our times and our culture call for innovative thinking on how to better the health care system. Perhaps you can join in this effort.

This week I interviewed Rebecca Onie, founder and CEO of Project Health. Here is her interview.

Interview with Rebecca Onie, JD, Founder and CEO of Project Health: A Social Innovation Designed to Close Gap between Poverty and Poor
Health Outcomes

Preface: In 1996, Rebecca Onie, now a J.D, then a Harvard student, founded Project Health with Barry Zuckerman, MD, a pediatrician at Boston City Hospital. The idea was simple, as many disruptive innovations are – recruit enthusiastic college students to direct families of pediatric patients to community sources of health care services, employment, housing, food stamps, and transportation. In other words, create a domestic Peace Corps to help poor families and to plug the gap between poverty and poor health. Project Health sets up a Family Help Desk in pediatric health care settings, and student volunteers steer families to where they can get help. Idealistic students, many pre-med, flock to these positions, which take 20 hours or so a week of their time. Project Health has spread to other major cities – Chicago, Providence, Baltimore, New York City, and Washington, D.C – and it will soon expand to two other cities.

Q: Let’s go back to 1996 when you co-founded Project Health with Dr. Barry Zuckerman, a pediatrician at Boston City Hospital. How did that come about?

A: As a Harvard undergraduate, I wrote an article in the Boston Globe magazine about Barry Zuckerman, then at Boston City Hospital, who had this radical view that the pediatrics department ought to be a place where kids actually got healthy. He had assembled a dream team to address the non-clinical needs of his patients – lawyers, doctors, social workers, nurses, and others.

I thought there could be a role for young people. He told me to spend six months talking to doctors and patients in the clinic, and then we could talk. I spent those six months of my sophomore year, wandering around the clinic talking to people. I said to the physicians, “What would you do if you had unlimited resources?” Many of them said they were frustrated. They would treat a child with an ear infection, but the real health issue was there was no food at home, and they were living in a car. They said they didn’t ask about those issues, because there was nothing they could do about them. I got this real sense of frustration among physicians. They were simply not set up for success. Project Health was born out of those conversations.

Q: How did you formalize the idea of Project Health?

A: I asked myself, how could we leverage this massive untapped resource of college students, who were ready, eager, and willing to serve humanity? How could I expand the capacity of the pediatric clinic to use this resource. The idea of student volunteers came to mind.

We began with a card table in the clinic. We were not sure either physicians or their families would want to talk to a college student. But from the onset, we were inundated with calls from physicians and self-referrals from patients. It was clear we had stumbled onto a powerful model. The program expanded rapidly to Providence, New York, Washington, D.C., and Chicago. It responded to that dual appetite to do significant work and to that sense of urgency that was present in pediatric clinics. The clinics were overwhelmed by patients’ social needs, and their limited capacities to meet those needs.

Q: Do you have many student volunteer applicants?

A: We have a very competitive application process. We accept about 15% of students. We have only a few open slots, and we have high retention rates. There is a huge interest among college students on the issue of health and poverty. Dr. Paul Farmer’s work in Haiti, and his book Mountains beyond Mountains, sparked some of that interest. As a college student, you may wonder how you can have a real impact on these issues. Project Health is one of the very few organizations that attract college students to help people suffering from poverty.

Project Health is an immediate and compelling experience for them. Talking to poor families about having no food at home and the impact of that on the health of their child moves these volunteers. The key motivator for these student volunteers is the opportunity to do significant work. That is of value to the health care system and that would otherwise not be provided.

Q: Does the fact that getting these volunteer assignments turn some students off that are not accepted ?

A: No, we use the model of college sports. Project Health is an extracurricular activity. It takes only 20 hours a week, and not everybody makes the team.

Q: Do the volunteers get any academic credit?

A: Not necessarily, not unless they independently arrange for it. Project Health doesn’t do anything to facilitate academic credits.

Q: I understand you train these students?

A: All of our students go through 18 hours of training in the clinics. That training includes everything from cultural competency. to how to navigate the social landscape in the community. to how to use the database system to make sure they’re recording high quality information. All of our volunteers are required to participate in weekly one hour to one sessions on campus to share experiences and to talk about difficult cases and connect to this landscape of health and poverty and career aspirations. Sometimes, the student will invite an outside speaker.

Q: They might want to invite Dr. Buz Cooper, a Professor of Medicine at the University of Pennsylvania. He says much of the variation in costs and high costs of medicine stems from poor outcomes in poverty-stricken inner cities because of advanced illness and delays in seeking treatment. Poverty is a cost issue, as well a humanitarian issue.

A: We look at our work as a gateway to better health. That is the core premise of our work – to close the gap between poverty and poor health. Access to care and quality of care are not enough in vulnerable populations. We have to go beyond that if we are going to see improvements in health outcomes.

Q: Have you thought of extending Project Health to the elderly?

A: Our dream is for this model to be pervasive in all clinics that are serving low-income patients. There are so many opportunities to expand, but we’ve decided for now to focus on children.

Q: Project Health strikes me as a domestic Peace Corps. Or I suppose you could call it Community Organizing, or even Disruptive Social Innovation. In any event, it’s exciting and caters to the idealism of college students with energy to burn.

Are many of these volunteers destined for a medical or health professional career? What is the mix of the students?

A: About 65% of our volunteers are pre-med. We attract a lot of students interested in medical school, nursing, social work, advocacy, policy, or public health work. Project Health creates a space where students can actually experience what the real world is all about.

Q: Critics might say. This is social work. Why can’t social workers handle this?

A: We work closely with social workers, but they are overwhelmed, and some of this work is outside their jurisdiction – legal, psycho-social, domestic violence needs, complex medical conditions, access to food, an exercise program, and a job-training program.

There’s also the reality of the ratio of patients to social workers. We work in one clinic in New York, for example, where there is one social worker for 47,000 patients. At Bellevue Hospital, there os one social worker for 12, 000 patients. There are simply not enough social workers to address all the patient needs, especially the preventative needs for families in crisis. Meeting these needs is not the most efficient use of professionals’ time. We want to expand a lay workforce to expand resource connections.

Q: So this is a socially disruptive innovation?

A: That’s exactly how we talk about it. This is a “social catalytic innovation,” to use the language of Clayton Christensen at Harvard Business School. That’s how we self-describe what we do.

Q: You’re the CEO of Project Health. Does this occupy you full-time?

A: More than full-time.

Q: This is a large-scale organization effort. Surely, there are large expenses involved. Where does the funding come from?

A: Historically the funding has been mostly philanthropic. We receive support from a number of individuals and foundations, including most notably, the Robert Wood Johnson Foundation. We are in the midst of a $2 million grant from the Foundation to expand our work.

Over the past few years, we’ve come to discover our hospital partners value these services and are going beyond providing in-kind support. Many of them now pay for these services as a core element of patient care they provide. We are looking at a business model to expand this hospital funding because it allows us to serve many more patients, and it can be a testament to how the health care system can actually meet the needs of patients. Our hospital partners are looking at this as a way of protecting their tax exempt status, as a way of integrating their physician services, and as a way of meeting quality of life objectives. This also has an element of medical school and residency education.

Q: What is the physician response to Project Health? I know they “prescribe” these services for volunteers to follow.

A: Physicians recognize how important this new resource is for their patients. When a Project Health Desk is present in their clinic, doctors immediately feel empowered to prescribe our services. The simple presence of our desk prompts them to engage us in helping their patients. This becomes a standard part of patient care and becomes integral to care delivery and part of the screening process.

Q: I wish you all the success in the world.

A: Thank you. We need physician champions like yourself to further our work. We appreciate your help in spreading the word.