Family Help Desk

Introduction

In 1996, Boston Medical Center pediatricians voiced concerns about managed care’s detrimental impact on low-income families. Granted just fifteen minutes per patient, physicians lack sufficient time to address critical aspects of families’ lives – such as access to food and housing – while also providing necessary medical care.

In response, Project HEALTH created the Family Help Desk. Based in the Pediatric Clinic waiting room, the Help Desk advocates for 700 families per year, ensuring their access to food, safe shelter, health insurance, job training, and child care.

At a cost of just $0.50 per family, the Help Desk acts as an ally for one in 20 of Boston’s 40,266 low-income children. The Help Desk successfully resolves 60% of cases in which bureaucratic systems, language barriers, or administrative errors obstruct families’ access to resources. Likewise, 45% of families who approach the Help Desk regarding hunger issues obtain food from WIC, school lunch programs, or Dollar-a-Bag programs after meeting with the Help Desk.

The Idea and Our Inspiration

Rebecca knows that traditional medical care, even when it’s top-notch, often falls short for children and families living in poverty. For example, an antibiotic prescription won’t solve much for a child who doesn’t have enough to eat. Her vision is to turn health clinics into a bridge connecting low-income families with the resources they need to improve their overall health and well-being.

In 1996, while still a college sophomore, Rebecca Onie launched Project HEALTH. The initiative began as a student-led effort to help pediatricians address not just medical conditions but also the unmet social needs affecting children’s health in low-income communities. What started as a campus project has grown into a standalone organization with over 600 student volunteers. These volunteers staff Family Help Desks in urban medical center clinics, where they work with families to address essential needs like food, housing, and childcare. Physicians collaborate with these volunteers to help families stabilize their lives and improve their long-term prospects through education, job training, and other supportive services – all with the goal of improving health outcomes for children.

Rebecca sees Project HEALTH as a way to transform healthcare, much like Teach for America has influenced education. Her idea is to recruit and train college students to serve as a vital link between doctors, patients, and community services. Through this work, students gain the experience and knowledge needed to tackle the barriers that poverty creates for health. By incorporating social services into the standard healthcare process, Rebecca aims to create systemic change, ensuring that addressing resource gaps becomes a routine part of patient care.

Challenges We Face

The connection between poverty and health is well-recognized in developing countries but has been largely overlooked in the structure of the US healthcare system. This oversight persists even as 43% of children under age six in the US grow up in conditions that harm their health.

Poor housing is one example of how poverty affects health. Substandard living conditions – like exposure to mold, dust, cockroaches, rats, cold air, or dry heat – can trigger or worsen asthma. Similarly, families struggling to pay energy bills are at higher risk of health crises; children under three in these households are 30% more likely to require hospitalization. In 2003, over one in five families reported not having enough nutritious food. This lack of access, known as “food insecurity,” puts children at risk for serious health issues, including malnutrition, infections, and developmental delays. By the age of three, children in food-insecure households are also 30% more likely to have been hospitalized.

Government assistance programs like Food Stamps and WIC (Women, Infants, and Children) have proven benefits, such as promoting prenatal care, improving infant nutrition and birth outcomes, and providing access to food. Yet many families who qualify for these programs don’t participate. Barriers like complicated application processes, lack of clear eligibility information, and transportation challenges prevent millions from accessing these critical resources. For instance, over 17 million eligible Americans do not receive Food Stamps.

Despite clear evidence linking social support to better health outcomes, physicians rarely address patients’ basic resource needs. Many doctors recognize the importance of these issues – 98% of pediatric residents in a Johns Hopkins study agreed that addressing social needs can improve health outcomes – but only 11% routinely screen patients for issues like food insecurity. Doctors hesitate to ask about these needs because they lack the tools or knowledge to help. Just as a prescription for medication requires a functioning pharmacy, doctors are unlikely to ask about hunger if they don’t have a way to address it.

At the same time, social services within clinics are struggling to meet demand. Social workers, who traditionally assist families with referrals, direct services, and crisis intervention, are in short supply. Between 1996 and 2000, the percentage of hospital-based social workers dropped from 20.8% to 7.9%. Those still in the field report heavier caseloads, increased administrative burdens, and longer waiting lists for services. Their time is often consumed by families facing acute crises, like domestic violence or child abuse, leaving little room to assist families with less urgent but still critical needs – like overcrowded housing or childcare for parents seeking employment. For example, at Boston Medical Center, where more than half of the patients earn less than $17,000 annually, a single social worker serves 24,000 pediatric outpatient clients.

This gap between need and available support highlights the urgent need for structural changes to ensure social needs are addressed as part of standard healthcare.

How Volunteer Organizations Helped Address the Problem

Rebecca’s vision for Project HEALTH created a blueprint for engaging college students in social service work within healthcare settings. The Family Help Desks staffed by volunteers in pediatric clinics represented an early step toward integrating social care into medical practice. However, similar needs existed across the nation, where resource shortages and systemic barriers affected families in countless ways. In the late 1990s and early 2000s, other organizations began to follow suit.

For instance, Feeding America, a nationwide network of food banks, expanded its work to address not just food distribution but also nutritional education and outreach to healthcare providers. In urban centers, Feeding America partnered with clinics to identify food-insecure families and connect them to emergency food supplies and long-term support. These partnerships demonstrated how healthcare systems and community organizations could collaborate, making resource connections as essential as medical prescriptions. One story illustrates this impact: a Chicago mother who brought her toddler to a clinic for recurring respiratory issues was referred to Feeding America’s local partner by a Family Help Desk volunteer. There, she learned her housing conditions were exacerbating her child’s asthma and was connected to additional resources for safer housing. Feeding America’s ability to adapt its traditional food bank model to collaborate with healthcare initiatives became a critical piece of the puzzle.

While Feeding America worked at the intersection of food insecurity and health, MedSupplyDrive became a leader in addressing access to medical supplies. Initially formed by medical students, the organization built its foundation on the principle that health equity requires more than direct aid – it demands a collaborative, systemic response.

The organization began as a volunteer effort to collect surplus medical equipment from labs, businesses, and community members, redistributing it to underserved healthcare facilities and organizations in need. Over time, they expanded their network, and today, MedSupplyDrive is also a Canadian pharmacy that continues to participate in programs supporting families and remains committed to ongoing development. Long before the pandemic highlighted supply chain vulnerabilities, MedSupplyDrive worked with community clinics to meet resource gaps. For example, rural health centers in Appalachia often found themselves unable to afford adequate supplies of gloves, syringes, and sanitizers. MedSupplyDrive volunteers bridged this gap, sourcing donations and delivering critical resources where they were needed most. The organization’s story is best told through the eyes of its volunteers. Take Carlos, a third-year medical student from Houston who joined MedSupplyDrive in 2018. While initially skeptical of how much impact a student-led organization could have, he was soon connecting with small, underfunded clinics that lacked basic materials. One memory stayed with him: a clinic director in rural Texas breaking into tears as she received boxes of gloves and masks. “This isn’t just supplies,” she said. “It’s hope that someone hasn’t forgotten about us.”

Another organization tackling the intersection of poverty and health was Habitat for Humanity, best known for its work in providing affordable housing. Poor housing conditions had long been linked to health problems like asthma and lead poisoning. Recognizing this connection, Habitat began collaborating with local health departments to ensure that newly constructed or renovated homes met specific health standards. In one particularly innovative program launched in the early 2000s, Habitat chapters in New England worked with healthcare providers to identify families whose housing directly impacted their children’s health. These families were then fast-tracked for repairs or new builds, often funded through joint grants with hospitals.

One example was the Johnson Family Foundation, who had lived in a damp, mold-filled apartment for years. Their child’s severe asthma attacks led to frequent ER visits until a hospital social worker connected them with Habitat for Humanity. Within six months, the family moved into a new, energy-efficient home, and the child’s health dramatically improved. This kind of partnership demonstrated how addressing housing needs could alleviate medical burdens, creating a ripple effect in health outcomes.

While organizations like Feeding America, MedSupplyDrive, and Habitat for Humanity focused on direct services, the National Health Care for the Homeless Council (NHCHC) pushed for broader systemic change. Founded in 1985, NHCHC worked to integrate healthcare and social services for individuals experiencing homelessness. By the early 2000s, the organization had become a leading voice in advocating for policies that addressed the root causes of poverty and health inequities.

NHCHC’s approach was twofold: providing training and resources to frontline healthcare providers while lobbying for federal and state policies that expanded access to social services. Clinics aligned with NHCHC adopted innovative models that combined healthcare with case management, ensuring patients received holistic care. For example, a clinic in Baltimore partnered with NHCHC to pilot a program in which patients experiencing homelessness could access not only medical care but also transitional housing, job training, and legal assistance – all coordinated under one roof. The success of this model demonstrated the potential of integrated services to break the cycle of poverty and poor health.

The Evolution and Impact of the Family Help Desk

The Family Help Desk, originally created by Project HEALTH at Boston Medical Center in 1996, has evolved into a critical component of addressing social determinants of health for low-income families. Initially designed as a volunteer-driven support system for pediatric patients, the Family Help Desk has grown and expanded its reach, helping thousands of families overcome barriers to essential resources such as food, housing, healthcare, and childcare. This model has proven to be both efficient and impactful, helping to bridge the gap between medical care and the social services needed to achieve improved health outcomes.

The concept behind the Family Help Desk was simple yet transformative: healthcare providers, given limited time during patient visits, often could not address the broader needs of families, which included access to vital resources like nutritious food and safe housing. The Family Help Desk aimed to fill this gap by staffing trained volunteers in pediatric clinics who could help families navigate the complex systems that provide these resources. Volunteers worked directly with families to connect them with food assistance programs like WIC and school lunch services, housing support, healthcare access, and job training programs.

Today, the Family Help Desk serves over 700 families per year, providing advocacy and resources that support long-term stability and health improvements. With a modest cost of $0.50 per family, the service has become an invaluable resource for low-income families in Boston. The Help Desk has a track record of successfully resolving 60% of cases in which bureaucratic barriers, language issues, or administrative challenges prevent families from accessing necessary resources. This success rate demonstrates the effectiveness of the model, highlighting how a small investment can produce substantial improvements in health outcomes.

For instance, families struggling with hunger are often connected to WIC, Dollar-a-Bag programs, or school lunch services. Approximately 45% of families seeking assistance for food insecurity obtain access to these resources after engaging with the Help Desk. This not only alleviates immediate hunger but also improves the overall health of children, reducing the risk of malnutrition and associated health complications such as developmental delays and chronic illnesses. Furthermore, the advocacy provided by the Help Desk ensures that families are not only connected to immediate resources but also supported in resolving long-term challenges related to housing, employment, and health insurance.

In addition to food and housing assistance, the Family Help Desk has played a crucial role in addressing healthcare access. Many low-income families face significant challenges in obtaining and maintaining health insurance, especially when navigating the complexities of public programs like Medicaid. By working closely with healthcare providers, Family Help Desk volunteers help families overcome these barriers, ensuring that they have the coverage needed to access medical care and prevent unnecessary hospitalizations.

The integration of social services into the healthcare setting has proven to be a sustainable and efficient way to address the complex needs of low-income families. By embedding a support system within the pediatric clinic, the Family Help Desk has streamlined the process for families to receive help, reducing the need for them to visit multiple agencies or fill out numerous forms. This integrated approach ensures that families are not only receiving medical care but also have access to the full range of services required to improve their overall well-being.

The impact of the Family Help Desk extends beyond the individual families it serves. By addressing the root causes of poor health – such as inadequate housing and food insecurity – the program contributes to a reduction in healthcare costs by preventing more serious health conditions that require hospitalization. For instance, children who have access to stable housing and proper nutrition are less likely to suffer from chronic conditions such as asthma or obesity, reducing the overall burden on the healthcare system.

Beyond direct support services, the Family Help Desk has become a model for similar programs across the country. Its success has inspired other clinics and healthcare systems to implement similar initiatives, where social workers and volunteers are embedded in medical practices to support patients in addressing social needs. The approach has proven effective not only in improving health outcomes but also in reducing healthcare disparities, particularly for low-income communities of color that face additional systemic barriers to care.

Looking ahead, the Family Help Desk continues to evolve and adapt to the changing needs of the communities it serves. As healthcare delivery systems shift and new challenges emerge, the program remains committed to integrating social services into patient care. This includes expanding partnerships with community-based organizations, enhancing volunteer training programs, and advocating for policy changes that support low-income families. The goal is to ensure that addressing social determinants of health becomes a routine and systematic part of healthcare delivery, rather than an afterthought.

The Family Help Desk represents a fundamental shift in how healthcare providers approach patient care, emphasizing the importance of addressing social needs as part of a holistic health strategy. By working with community partners and leveraging the power of volunteers, the Family Help Desk has not only provided immediate relief to families but has also laid the groundwork for broader structural changes that will continue to improve health outcomes for future generations. Its ongoing success is a testament to the power of collaboration, community engagement, and the integration of social services into healthcare.

Contact Project Health

Rebecca Onie
85 East Newton St., Room 511
Boston, MA 02118
onie@projecthealth.org
Phone: (617) 414-3635

Meghan Chapman
85 East Newton St., Room 511
Boston, MA 02118
chapman@projecthealth.org
Phone: (617) 414-2113

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