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The Student Health Outreach Project

There are nearly 41 million uninsured children and adults in this country. More than 9 million of them are children and teens. In an effort to provide health insurance to the uninsured children in our 50 states, in 1997 Congress passed the $48 billion State Children's Health Insurance Program (SCHIP) which has offered an unprecedented opportunity to provide health coverage to our nation's children. New York State gets millions of dollars a year through SCHIP to provide New York's 529,000 uninsured children with health coverage. In addition, in October of 2001 New York rolled out the Family Health Plus program which provides health insurance to uninsured low income adults whose incomes are too high for Medicaid. There are more New York children, teens, adults, and immigrants than ever before who are eligible for free and low cost health insurance, but may not realize it. Remaining challenges include identifying uninsured children and adults, educating families about the importance and availability of affordable health insurance, and helping them get to the point of enrollment. To meet these challenges, the Children's Defense Fund has been organizing an army of student volunteers to partner with community-based outreach and enrollment efforts. Students fill an important role by focusing on identifying uninsured children and adults and linking families to enrollment. This dynamic endeavor is called the Student Health Outreach Project (SHOUT).

SHOUT is an initiative of the Children's Defense Fund which aims to involve students in high school, college and graduate school in a national effort to enroll children and families in health insurance. SHOUT trains students, educates families about the availability of free and low-cost health insurance, and then links these families to enrollment sites in their communities. SHOUT also creates opportunities for students to share their experiences and best practices.

SHOUT in New York
CDF-NY piloted SHOUT in partnership with Columbia Universityin September of 1998. Students were recruited, trained and placed in Washington Heights and Harlem community-based organizations (CBOs) to serve as enrollment workers. At the time, there was no community-based enrollment system in New York. Columbia students staffed nine enrollment sites for two hours a week. Outreach was conducted by the organizations and by an active group of high school students from the youth organization, Prep for Prep.

The SHOUT pilot grew out of a desire by CBOs to expand health insurance enrollment opportunities in their communities, and to expand their own involvement in enrolling the uninsured given their limited resources. A key aspect of the SHOUT model is that students support already-existing community-based efforts, and don't have to reinvent health insurance outreach and enrollment campaigns. While media campaigns and simplified enrollment systems are being implemented across the country, the challenge remains to identify uninsured children and adults and get them to the point of enrollment. Students can fill this gap in the overall outreach and enrollment strategy.

In 2000, New York State awarded grants to community-based organizations to complete children's health insurance applications through a system called facilitated enrollment. The opportunity created by state-funded facilitated enrollment organizations resulted in a shift of strategy to focus on outreach and education in SHOUT's second and third year. Today, Shout's strategy focuses on identifying families with uninsured children or adults, educating them about the availability of free and low-cost health insurance, and linking them with enrollment sites in their neighborhood.

Learning from the experience of the Columbia SHOUT project, CDF-NY expanded SHOUT in New York State to include a variety of models of student involvement in health insurance outreach and enrollment. CDF-NY has continued to involve students through such youth organizations as Prep for Prep and high school extracurricular programs at Stuyvesant High School, the Queens Bridge to Medicine Program, the American Medical Association Student Section, classes at Skidmore and North Country Community Colleges, and the work-study program at LaGuardia Community College. There is no one way to conduct a SHOUT project; SHOUT can take many different forms.

Building on the success of SHOUT, the Children's Defense Fund has launched a new, national initiative, called SPROUT (Student Poverty Reduction OUTreach Program), to help fight poverty. This school year, SHOUT-NY has grown to include SPROUT. More than 900,000 of New York's children live in poverty. Their families struggle to provide for their basic needs including healthcare, nutritious food, safe housing and childcare. In addition to public health insurance, volunteers throughout New York are educating families about critical public benefits such as Food Stamps and the Earned Income Tax and Child Tax Credits, which help lift families out of poverty. Although these public benefits can provide important support to families, many are unaware that they exist or don't realize they may be eligible. As demonstrated with health insurance enrollment, SHOUT/SPROUT volunteers make a significant difference in helping to link families with resources to meet their basic needs.

Examples of Current SHOUT Models:

• Youth Organization/Student Association Model. Students participate in SHOUT as part of their youth organization or student association. Members can focus on educating their peers and/or their community about the availability of health insurance and enrollment opportunities. Youth have participated in SHOUT through ongoing community outreach efforts seeking to link families with enrollment sites and/or special enrollment days. The student association model focuses on educating students about the issue of health insurance and encouraging them to devise outreach efforts and referral systems in their affiliated hospitals and clinics. Outreach can take place in the students' professional environment (i.e. the health institutions for the medical students) or in conjunction with other community outreach projects (i.e. incorporating health insurance information into health education curricula). Activities have included distribution of educational materials, street outreach, and presentations. Specifically, CDF-NY has partnered with the American Medical Association Student Section, whom adopted SHOUT in September 1999 as its statewide service project for the 14 medical schools in the state. In December of 1999 and 2000, the national association adopted SHOUT as its national service project for the 140 medical schools in the country.
  
  
• Class Project/Service Learning Model. Students participate in SHOUT as part of a class with a community service component. As part of the class curriculum, students learn about health insurance and about outreach and referral strategies. They are charged with devising successful outreach efforts in their communities. Students are responsible for identifying families with uninsured members and tracking them through the enrollment process. Queens Bridge to Medicine students are currently doing health insurance outreach in local subway stations and are also giving presentations to students enrolled in ESL and GED classes at a local college.
  
  
• Community Service Day Model. Schools often sponsor community service days or drives. Students participate in SHOUT as part of a one day or periodic outreach effort. Special community service days have proven very successful. In conjunction with Columbia SHOUT, more than 100 students distributed 40,000 pieces of literature in one day as part of a university-wide community service day. The Prep for Prep students have had similar successes by recruiting students from their schools for large outreach days.
  
  
• Field Placement/Internship/Work-Study Model. Students participate in SHOUT through an internship or field placement which is required as part of their studies, or their school work-study program. Several graduate students from Hunter School of Social Work and Columbia School of Public Health have fulfilled field placements through SHOUT by serving at agencies doing health insurance outreach. LaGuardia Community College work-study students, assigned to the Health Center as health outreach workers, give presentations to students, and staff tables during weekly "club days."
  
  
• SHOUT Club Model. Students participate in SHOUT as part of a SHOUT club. At Columbia University, SHOUT is a grant-funded program and part of Community Impact, the university's community service umbrella organization. Staffed by a part-time graduate student coordinator, three part-time undergraduate organizers and student volunteers, the club is partnering with community-based organizations in Northern Manhattan that are enrolling children and adults in health insurance programs.