May 2011Volume 24, Number 3

What we think about, and what we’d like you to think about

Published as a community service by The Abell Foundation

The Abell Report

By Heather L. Schwartz, Ph.D.

IIn 1966, the Coleman Report firm-ly established the link between afamily’s socioeconomic status and achild’s educational outcomes. Known asthe “income achievement gap,” the dis-parity between the achievement of poorand rich children has becomeentrenched in our nation’s educationallandscape: with few exceptions, schoolswith high concentrations of studentsfrom low-income families perform farworse than schools with lower concen-trations of poverty. [i] Some 45 yearsafter the report’s release, debate contin-ues about how to positively impact theachievement of economically impover-ished children.Education and housing are two pri-

mary means in U.S. public policy topromote social mobility. Yet the vastmajority of our efforts to improveschool performance focus on what hap-pens within the walls of the schoolhousewith reforms such as reducing class size,increasing time spent in school, promot-ing school competition and choice, ordeveloping more rigorous standards.While some reforms have shown prom-ise, it is not clear that schools alone canclose the large achievement gap betweenrich and poor children.

Fifty miles to the south of BaltimoreCity, Montgomery County operates twopolicies that aim to close the incomeachievement gap. One is a more tradi-tional school-only reform that investsextra resources and funding in its need-iest elementary schools, or “red zone”schools. The other illustrates the powerof housing and schools to improve theoutcomes of disadvantaged students: Itis a novel housing policy that providesrobust economic integration to reducethe negative effects of poverty on chil-dren through combined housing, neigh-borhood, and school influences.To analyze the effectiveness of the

schools-only versus the combinedapproach of investment in both hous-ing and schools, my study, Housing Pol-icy is School Policy: Economically Integra-tive Housing Promotes Academic Successin Montgomery County Maryland (TheCentury Foundation, 2010) comparedtwo groups of children who lived inpublic housing. The study finds thatthose students who were integrated intolow-poverty schools (through the place-ment of their families’ housing assign-ment into a low-poverty neighborhood)far outperformed those who attendedthe higher-poverty but higher-resourced “red zone” schools. More

“Like hitting the public health jackpot.”

In an anteroom off of the receptionarea of the Harriet Lane Children’sCenter of The Johns Hopkins Hospital,three Hopkins undergrads are seated ata counter, engaged one-on-one in con-versation with patients. The patientshave just seen a doctor, who has “pre-scribed” a social service, just as he orshe has prescribed a medicine, and sud-denly, following the visit, now have abewildering list of things they need out-side of any medical regime. But they aremostly poor and disadvantaged; theylack the wherewithal to work the socie-tal systems and make things happen inan increasingly complex world. They donot know where to turn. Visiting thisdesk on this day, they have turned tothe right place: the three Hopkins stu-dents are trained in the art of where tofind anything and how to make thingshappen, easing the way for thesepatients to get on with their lives.These young people -- and there are

more than 300 of them at work in theprogram in any given year in Baltimorealone -- are not your father’s socialworkers, or health counselors, or educa-

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ABELL SALUTES:Health Leads – DoctorsIdentify Patients’ UnmetResource Problems,College Students HelpResolve Them

Is Montgomery County’s HousingPolicy One Answer to Baltimore’sEducation Achievement Gap?Montgomery County offers lessons about the educational benefits ofhousing-based economic integration

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importantly, those highly disadvantagedchildren who had access to the district’slowest-poverty schools began to catchup to their more-affluent, high- per-forming peers, cutting in half theincome achievement gap by the end ofelementary school.Children in low-income households

derive substantial benefits from livingin low-poverty neighborhoods andattending low-poverty schools.

Case Study: MontgomeryCounty Schools and the IncomeAchievement GapSince Montgomery County first

incorporated after World War II, it hasbeen one of the country’s most affluentsuburbs. By 2009, it had also becomequite racially diverse. The latest figuresshow that the county has almost a mil-lion residents: of these, a little morethan half (52 percent) are white, withthe balance somewhat evenly splitamong blacks, Hispanics, and Asians.Montgomery County also operates oneof the most acclaimed large publicschool systems in the country – servingover 140,000 students. It graduatesnine out of 10 students, and the averageSAT score in the district greatly exceedsthe national average. Further, two-thirds of its high school students take at

least one Advanced Placement course.The historically strong relationship

between student income and academicperformance is one important factorthat helps to explain the county’s com-mendable school statistics. Only aboutone in three students who attendsMontgomery County public schoolsqualifies for a free or reduced-pricemeal. In urban districts such as Chica-go, New York, and Los Angeles, morethan three of every four students quali-fy for a free or reduced-price meal—andin Baltimore City, over 80 percent ofstudents qualify for subsidized meals.Although the Coleman Report

linked a family’s socioeconomic statusto a child’s educational outcomes backin 1966, questions still abound regard-ing the magnitude of a school’s effectcompared to other influences such ashome environment or genetics. Theo-retically, there are multiple potentialbenefits of attending low-povertyschools. Research has shown that, whencompared to high-poverty schools, low-poverty ones attract and retain morehighly qualified teachers, obtain higherlevels of parental stewardship; attractbetter-prepared students who are lesslikely to move or be absent, and havemore positive school climates character-ized by lower levels of confrontationand chaos.While it may seem intuitively obvi-

ous that a child from a disadvantagedfamily would benefit academically fromthe resources that low-poverty schoolstypically offer, there are two primary rea-sons that explain why we lack consensuson this issue. First, there is the relativeinfrequency of many low-income fami-lies with long-term access to low-povertyschools. Second, when highly motivatedlow-income families do select into low-poverty schools, that selection castsdoubt on whether the observed perform-ances of such students are caused by theirsetting or are simply artifacts of their

motivation and dedication.In light of these challenges, three

historical features make MontgomeryCounty an ideal location to studywhether low-income children doindeed benefit from attending low-poverty schools. Each of these is dis-cussed in greater detail below.

1. About 35 years ago, MontgomeryCounty pioneered the concept ofinclusionary zoning (IZ) byadopting a zoning restriction thatmandates real estate developers toset aside a portion of the homesthey build to be rented or sold atbelow-market prices. In exchange,these developers obtain a densitybonus that allows them to buildmore square feet per acre thanwould otherwise be the case, allow-ing developers to recoup the finan-cial loss on the IZ homes. This hasresulted in the production of morethan 12,000 moderately pricedhomes in the county since 1974.

2. Among more than 500 jurisdic-tions in the U.S. that have adoptedIZ, Montgomery County’s policy isone among only a few that pro-vides its public housing authoritywith the legal right of first refusalto purchase some of the IZhomes. Exercising this legal right,the housing authority has pur-chased, among other types of sub-sidized homes, approximately 700IZ townhomes, single- familyhomes, and apartments that itoperates as federally subsidizedpublic housing. This means thatabout 700 very low-income fami-lies who are typically below thepoverty line receive substantial sub-sidies to lower their rent and live invery low-poverty places throughoutthe county that they could not oth-erwise afford.

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“Children in low-incomehouseholds derivesubstantial benefits

from living in low-povertyneighborhoodsand attending

low-poverty schools.”

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3. The public housing authorityrandomly assigns families topublic housing. This means thatfamilies who live in public housingwithin Montgomery County donot get to choose their neighbor-hood (and by extension, the zonedelementary school). Not only isthis highly unusual, but it is alsothe most important feature of thestudy because it enables a fair com-parison of (a) public housing stu-dents who attend the elementaryschools with the lowest povertyrates to (b) public housing studentswho attend the elementary schoolsin the county with moderatepoverty rates.

For these reasons, families earningincomes below the poverty line arewidely dispersed throughout Mont-gomery County. A little more than 850

children lived in Montgomery Countypublic housing and attended grades 2 -6, the tested grade levels, for at least twoconsecutive years between school years2001 and 2007. About one-half ofthem attended schools where less than20 percent of their schoolmates quali-fied for a free or reduced-price meal(what this study labels low-povertyschools). The balance attended schoolswhere 20 percent to 65 percent ofschoolmates qualified for a free orreduced-price meal (moderate-povertyschools). It is these 850 children whoare the subjects of the study below.

An Affluent Suburb Chooses toIncrease its Affordable HousingWith a shortage of workers to fill its

lowest-paid jobs and an overheatedhousing market that was pricing outmiddle-class residents, MontgomeryCounty voted in 1974 to increase itssupply of what it called “moderatelypriced dwelling units” or MPDUs.Specifically, the county created thenation’s first inclusionary zoning pro-gram by requiring that all real estatedevelopers of market-rate developments,as a condition of zoning approval, setaside between 12 percent and 15 per-cent of the units as MPDUs to be rent-ed or sold at below-market prices. Indoing so, Montgomery County createda policy that not only increased the sup-ply of its affordable housing stock, butdid so in a manner that would preventthe concentration of poverty.Similar smaller-scale policies have

since spread to many other high-costhousing markets throughout the UnitedStates. IZ experts Nico Calavita andAlan Mallach, authors of Inclusionary

Housing in International Perspective,estimate that more than 500 localitiesoperate an inclusionary zoning policywithin this country.Aside from being the largest IZ pro-

gram, Montgomery County’s Inclusion-ary Zoning policy is unique in that itallows not only moderate-income fami-lies, but also very low-income ones, tolive in affluent neighborhoods through-out the county. It does so by providingits public housing authority, the Hous-ing Opportunities Commission(HOC), with the right of first refusal topurchase up to one-third of all IZ units.To date, the HOC has purchasedapproximately 1,500 MPDUs. Of these,about 700 are scattered-site public hous-ing rental homes (the subject of thestudy described here); 250 were sold tohomeowners; and the remaining unitsare rentals subsidized by a combinationof federal, state, or local funds.All told, the HOC operates almost

992 public housing homes in the coun-ty, of which 700 were purchasedthrough the County’s inclusionary zon-ing program as previously mentioned,with the balance clustered into fivesmall public housing developments.Families who occupy the public hous-ing apartments in Montgomery Countyhave an average income of $22,460 asof 2007, making them among the poor-est households in the county. The apart-ments are leased at a fraction of the nor-mal market rates: Average monthly rentfor a two- bedroom apartment inMontgomery County in 2006 was$1,267; a public housing tenant’s aver-age rent contribution was $371 (one-third of income, per federal regulation)that same year.

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“Montgomery County’sInclusionary Zoning

policy is unique in thatit allows not only

moderate-income families,but also very low-incomeones, to live in affluent

neighborhoods throughoutthe county.

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Pictured above are three of the fivepublic housing family developments inMontgomery County. Each develop-ment ranges from 50 to 75 public hous-ing units.One the right are examples of mar-

ket-rate developments where 12 to 15percent of the homes are set aside asinclusionary zoning units to be sold orrented at below-market rates. The hous-ing authority has the option to purchaseup to 33 percent of the inclusionaryzoning units in any given subdivisionand operate them as scattered-site pub-lic housing units for families. To date,there are about 700 such scattered-sitepublic housing units in the county.

The HOC randomly assigns eligibleapplicants to public housing, which isimportant from a research perspective.This policy has the effect of randomlyassigning children to public elementaryschools because 129 of the county’s 131elementary schools are residentiallyzoned. It prevents families’ self-selec-tion into neighborhoods and elemen-tary schools of their choice, which inturn allows for a fair comparison ofchildren in public housing in low-poverty settings to other children inpublic housing in higher-poverty set-tings within the county.To qualify for public housing during

the years examined in this study, ahousehold first had to sign up on awaiting list. Income-eligible householdscould only get on the waiting list bysubmitting an application to the hous-

ing authority during a 14-day windowthat occurred every other year. Severalthousand households did so each time(applicants must resubmit each timethe waiting list is reopened), so any giv-en applicant had approximately a 2 per-cent chance of being selected via rollingcomputerized lotteries. The lotteryselection of applicants was withoutrespect to seniority. As public housingapartments became available, the hous-ing authority offered each randomlyselected household up to two size-appropriate public housing apartmentsof the housing authority’s own choos-ing. Approximately 93 percent of pub-lic housing households selected the firstoffer, and they typically did not knowthe location of the second unit at thetime the first offer was made. House-holds that rejected both offers wereremoved from the waiting list.The initial random assignment of

families to apartments persisted, due totight restrictions by the housing author-ity on internal transfers and to a lowturnover rate among public housingfamilies with children: 96 percent ofchildren in public housing remainedenrolled in Montgomery County publicschools during the study period, and 90percent of the children in public hous-ing in the sample remained in the orig-inal elementary school to which theywere assigned.

Effects of Economically Integra-tive Housing on EducationThe primary intent of the MPDU

program is to allow lower- or moderate-income households to live near wherethey work. But the HOC’s participa-tion in the county’s IZ policy in partic-ular has also had the effect of allowingfamilies who typically earn incomesbelow the poverty line to send theirchildren to schools where the vastmajority of students come from familiesthat do not live in poverty. As shown in

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Sources: Housing Opportunities Commissionand Montgomery County Department ofHousing and Community Affairs

Figure 1. Photographs of public housing inMontgomery County, MD

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Figure 2 below, most of the elementaryschools that public housing studentsattended had poverty rates between 0percent and 40 percent. This distribu-tion is significant because the vastmajority of schools in the United Stateswith high concentrations of studentsfrom low-income families perform lesswell than schools with low concentra-tions of poverty. In 2009, more thanone-half of fourth and eighth graderswho attended high-poverty schoolsfailed the national reading test, com-pared to fewer than one in five studentsfrom the same grade levels who attend-ed low-poverty schools.One way to quantify the low-pover-

ty school effect is to compare the testscores of public housing children in thelow-poverty schools to the test scores ofpublic housing children in the moder-ate-poverty schools. As shown in Figure3, after five to seven years, students inpublic housing who were randomlyassigned to low-poverty elementaryschools significantly outperformed their

peers in public housing who attendedmoderate- poverty schools in bothmath and reading. Further, by the endof elementary school, the initial, largeachievement gap between children inpublic housing who attended the dis-trict’s most advantaged schools and

their non-poor students in the districtwas cut by one-half for math and one-third for reading.As anticipated, the academic returns

from economic integration diminishedas school poverty levels rose. Childrenwho lived in public housing and attend-ed schools where not more than 20 per-cent of students qualified for a free orreduced-price meal did best, whereasthose children in public housing whoattended schools where as many as 35percent of students qualified for a freeor reduced-price meal performed nobetter academically over time than pub-lic housing children who attendedschools where 35 percent to 85 percentof students qualified for a free orreduced-price meal. (Note: Fewer than5 percent of schools had more than 60percent of students from low-incomefamilies, and none had more than 85percent in any year, making it impossi-ble to compare the effects of low-pover-ty schools with truly high-povertyschools, where 75 percent to 100 per-cent of the families are low income.)

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0

29

25

13

18

11

15

54 4

1

4020 60 80

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0-20% of schoolmates in previous year qualified for FARM*20-85% of schoolmates in previous year qualified for FARM*

2 4 5 6 7

Figure 2 – Distribution of poverty among the elementary schools attended by public housingstudents (2006)

Figure 3 - Effect of low-poverty schools on public housing children’s math scores. Average districtmath score.

Average District Math Score

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Comparing the Impact of the“Red Zone” Policy

The results of Montgomery Coun-ty’s economic integrative housing arepromising, particularly when comparedwith its “red zone” educational initia-tive. This policy allows for a test ofwhether extra resources within theschoolhouse could overcome the disad-vantage of attending a high-povertyschool. In the late 1990s, the districtconducted some research and foundthat its third graders’ academic perform-ance could perfectly predict their subse-quent level of participation in AP andhonors courses in high school. So in2000, the county adopted a policy todirect extra resources to its 60 mostneedy elementary schools in order tointroduce full-day kindergarten, reduceclass sizes, provide greater time for liter-acy and math, and provide extra profes-sional development to teachers. These60 schools are termed “red zone”schools, while 71 other elementaryschools are considered “green zone”schools. As Figure 4 shows, despite these

extra resources, by the end of elemen-tary school, public housing childrenwho attended “green zone” elementaryschools still substantially outperformedtheir “red zone” public housing peers.

Applicability to Other SettingsMost education research attempts to

quantify the effects of various promisingschool-based reforms for low-incomechildren, many of which MontgomeryCounty has embraced, including full-day kindergarten, smaller class sizes inearly grades, a balanced literacy curricu-lum, and increased professional develop-ment. However, the results from thisstudy suggest that the efforts to enrolllow-income children in low-povertyschools have proven even more powerful.Because education is an investment

with both individual and societal bene-fits, improving low-income students’school achievement using integrativehousing is a tool that not only can reducethe income achievement gap but also canhelp stem future poverty. Furthermore,the experience of Montgomery County

shows that it can be in the self-interest ofboth localities and low-income familiesto create economically integrated neigh-borhoods and schools.With a need for an economically het-

erogeneous population, MontgomeryCounty has sought since the 1970s todirect and spatially spread the growth ofits lower-income households throughoutits jurisdiction. Hundreds of other high-cost jurisdictions have also sought toincrease and spread their supply ofaffordable housing, albeit in small num-bers, via inclusionary housing policies.These results underline the impor-

tance of schools, in general, to studentachievement, but they also stress theimportance of the many advantages thatlow-poverty schools offer. Keeping inmind that this study examined childrenof low-income families who opted to livein an affluent suburb, what can theMontgomery County experience teachus about cities like Baltimore withextremely high rates of poverty, but thatare nevertheless surrounded by countieswith greater wealth?

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Number of years the child is enrolled in the district

4 5 6 72

Child attended a green zone* elementary school in previous yearChild attended a red zone* elementary school in previous year

green zone schs.

red zone schs.

The effects of attending green zone vs. red zone schools on public housing students’ math and reading scores

*Green and red zone schools refers to a MCPS initiative to heavily invest in grades K-3 within in its 60 highest-need (i.e., red zone) ele-mentary schools.

Figure 4 – Effect of “green zone” / “red zone” on public housing children’s math and reading performance.

3

Number of years the child is enrolled in the district

4 5 6 72

Child attended a green zone* elementary school in previous yearChild attended a red zone* elementary school in previous year

green zone schs.

red zone schs.

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One lesson is that counseling forfamilies participating in housing mobili-ty programs like Housing ChoiceVouchers, the single largest HUD rental-assistance program, could include infor-mation or guidance not just aboutregional housing but also about theregional school market. Furthermore,economically integrative assignmentpolicies could benefit low-income chil-dren, although obtaining economic inte-gration that would permit low-incomechildren to live in very low-povertyneighborhoods and attend very low-poverty schools would require unprece-dented cooperation between BaltimoreCity and its surrounding counties.Another lesson: that student assignmentto schools, whether through schoolattendance zones or school choice poli-cies, can have significant consequencesfor students. As many as 60 school dis-tricts in the U.S. employ student assign-ment policies that explicitly balance stu-dent poverty across schools.The Montgomery County example

is not a one-size-fits-all solution forevery jurisdiction. But it underscoreshow investments in housing, roads, orpublic transit that affect where peoplelive can have positive educationalimpacts, particularly when they providelow-income children with access to eco-nomically integrated communities andschools. As such, the example offersregional lessons for Baltimore abouthousing mobility, and it underscores theimportance to the entire community ofeconomic integration. A strategy thatpromulgates “housing policy as educa-tional policy” belongs as a discussionitem on the community agenda.

The study, Housing Policy is School Policy:Economically Integrative Housing PromotesAcademic Success in Montgomery CountyMaryland (The Century Foundation, 2010)can be accessed at http://tcf.org/publications/pdfs/housing-policy-is-school-policy-pdf/Schwartz.pdf

Endnotes

1 S. Aud, W. Hussar, M. Planty, T. Snyder, K. Bianco, M. Fox, L. Frohlich, J. Kemp, and L. Drake,The Condition of Education 2010, NCES 2010-028 (Washington, D.C.: National Center for Edu-cation Statistics, 2010).

2 U.S. Bureau of the Census, County Population Estimates by Demographic Characteristics - Age,Sex, Race, and Hispanic Origin; updated annually for states and counties.http://www.census.gov/popest/counties/asrh/. 2000 Census of Population and Housing for places;updated every 10 years. http://factfinder.census.gov.

3 For studies on teacher sorting, see for example B. A. Jacob, “The Challenges of Staffing UrbanSchools with Effective Teachers,” The Future of Children 17, no. 1 (2007): 129–53; E. A.Hanushek, J. F. Kain, and S. G. Rivkin, “Why Public Schools Lose Teachers,” The Journal ofHuman Resources 39, no. 2 (2004): 326–54; D. Boyd, H. Lankford, S. Loeb, and J. Wyckoff, “TheDraw of Home: How Teachers’ Preferences for Proximity Disadvantage Urban Schools,” Journal ofPolicy Analysis and Management 24, no. 1 (2005): 113–32; D. Boyd, H. Lankford, S. Loeb, and J.Wyckoff, “Explaining the Short Careers of High-achieving Teachers in Schools with Low- perform-ing Students,” American Economic Review 95, no. 2 (2005): 166–71; B. Scafidi, D. L. Sjoquist, andT. R. Stinebrickner, “Race, Poverty, and Teacher Mobility,” Economics of Education Review 26(2007): 145–59. For ethnographic studies about high poverty school environments, see J. M.Parr and M. A. R. Townsend, “Environments, Processes, and Mechanisms in Peer Learning,” Inter-national Journal of Educational Research 37 (2002): 403–23; M. Thrupp, “A Decade of Reform inNew Zealand Education: Where to Now? Introduction,” New Zealand Journal of Educational Stud-ies 34, no. 1 (1999): 5–7; M. Thrupp, “Education Policy and Social Change,” British Journal ofSociology of Education 23, no. 2 (2002): 321–32. For studies about parental interactions withschools, see A. Lareau and E. M. Horvat, “Moments of Social Inclusion and Exclusion: Race,Class, and Social Capital in Family-School Relationships,” Sociology of Education 72, no. 1 (1999):37–53; E. M. Horvat, E. B. Weininger, and A. Lareau, “From Social Ties to Social Capital: ClassDifferences in the Relations between Schools and Parent Networks,” American Educational ResearchJournal 40, no. 2 (2003): 319–51. For studies about teacher expectations and student-teacherinteractions, see A. Lareau, “Social Class Differences in Family-School Relationships: The Impor-tance of Cultural Capital,” Sociology of Education 60, no. 2 (1987): 73–85; S. Lasky, “The Culturaland Emotional Politics of Teacher-Parent Interactions,” Teaching and Teacher Education 16, no. 8(2000): 843–60; P. Hauser-Cram, S. R. Sirin, and D. Stipek, “When Teachers’ and Parents’ ValuesDiffer: Teachers’ Ratings of Academic Competence in Children from Low-income Families,” Jour-nal of Educational Psychology 95, no. 4 (2003): 813–20.

4 Since the housing authority does not track rejected offers, this statistic was derived from sixmonths of offers made during 2008.

5 High-poverty schools are here defined as those with 75 percent or higher concentrations of stu-dents who qualify for a free or reduced-price meal (those who come from families making less than185 percent of the poverty line). Fifty-five percent of fourth graders and 47 percent of eighthgraders scored “below basic” on the National Assessment of Educational Progress in 2009 in high-poverty schools, whereas 17 percent of fourth graders and 13 percent of eighth graders scored“below basic” from schools were less than 20 percent of students qualified for a free or reduced-price meal. S. Aud, W. Hussar, M. Planty, T. Snyder, K. Bianco, M. Fox, L. Frohlich, J. Kemp, andL. Drake, The Condition of Education 2010, NCES 2010-028 (Washington, D.C.: National Centerfor Education Statistics, 2010).

6 Our call to action (1999). Rockville, MD: Montgomery County Public Schools.7 Richard D. Kahlenberg, “Turnaround Schools that Work: Moving beyond Separate but Equal,”Agenda Brief, The Century Foundation, 2009.

Heather L. Schwartz, Ph.D., is an associate policy researcher at theRAND Corporation in New Orleans, Louisiana. She received herdoctorate in education policy from Teachers College, Columbia University.Her research regards housing and schooling policies intended to reducethe negative effects of poverty on children. She currently co-leadsa MacArthur Foundation-funded study of inclusionary zoningand schools in 10 cities.

EDITOR’S NOTE: A copy of the report, Is Montgomery County’s Housing Poli-cy One Answer to Baltimore’s Education Achievement Gap?: Montgomery Countyoffers lessons about the educational benefits of housing-based economic integration,is available in “Publications” on the Abell website, www.abell.org.

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tional advisors. Working in a programcalled Health Leads (formerly ProjectHEALTH), they are redefining tradi-tional social services, acting in all thesecapacitiesto one degree or another, toprovide practical guidance to the vary-ing and disparate (non-medical) needsof patients.One patient, for example, may be in

a desperate situation with a sick child,no heat and unpaid utility bills; anotheris up against it after breaking up with hislive-in girl friend, moving out and lack-ing a way to support himself and hisyoung daughter. Other life crises sharedover the counter include hunger, obsta-cles to earning a GED, and suddenhomelessness. In each case: what to do,where to go?Working with a stack of directories,

a computer, and a Roledex, the studentassigned to a case will locate, identify,hasten along, cajole, make things hap-pen and become a positive force inchanging their patients’ lives. SaysJoshua Sharfstein, M.D., Maryland Sec-retary of Health, “The program lines uptremendous resources against a tremen-dous need.”Dr. Sharfstein learned about Health

Leads when he was doing his pediatricresidency at a hospital in Boston, wherethe service was started in 1996 by Har-vard College graduate Rebecca Onie,who still runs the organization out of itsheadquarters there. Sharfstein said heencouraged Onie to expand HealthLeads to Baltimore 2006, where for thefirst time the program is being integrat-ed with a public health agency and thequasi-public agency Baltimore Health-Care Access, rather than with a hospi-tal’s pediatric offices. Funds to coverHealth Leads first two years in Balti-more -- $250,000 total--came from

local groups, including Leonard E. Stul-man Charitable Foundation and TheAbell Foundation. “To be able to line upthe energy of these college students withpeople who desperately need help is likehitting the public jackpot, said Dr.Sharfstein, noting the more than 8,000children and adults served by the pro-gram in Baltimore each year.On this particular day at the count-

er, Student A sees Tanya (not her realname,) a 19-year old single mother whois in school five days a week. “She cameto me the moment she stepped out ofher doctor’s office across the hall. Thedoctor, taking in her health situation,had taken into account, too, her life sit-uation, and written a ‘prescription’ todeal with both. One prescription wouldbe going to her pharmacist, the other tome. The doctor recommended day-carefor her 14-month old child, vouchersand a job. I was able to give her instruc-tions on how to obtain vouchers andchild care and how to connect with thenearest department of Social Services.She told me a month or so later, ‘I gotyour instructions. I got the vouchers. Igot the child care I asked for. I can’tthank you enough.’”Student B worked with Kandasmy

(also not her real name). “Kandasmy isa woman with two children-- one inelementary school and another in herlate teens-- who came to me with herproblems. The older daughter has sick-le cell anemia and has been in and outof the hospital. The mother could onlywork some of the time, caught betweencaring for her child in school; and goingto and from the hospital to be with herolder daughter. Her heat and utilitybills were in danger of being cut off sothe first thing I did was get her daugh-ter emergency bus tokens—so shecould mange her own transportation,and provide some relief for her mother.I then was able to work, successfully,with the utility company so that they

would not shut off her utilities. I thenhelped her switch to a job with betterpay and more flexible hours. I helpedher get her younger child into an afterschool tutoring program. Months latershe told me, ‘I’m really grateful thatthere is someone out there who wouldgo the extra mile for me.’”Student C reported that “My client’s

son lost his health insurance when hemoved from Maryland to Rhode Islandto attend high school and she wasexhausted from trying and failing to getit reinstated. After her primary careprovider referred her to us I was able towork with her providers and our legaladvisor, and to get her son’s health insur-ance reinstated in Maryland. Within amonth, the client told me, ‘I can’tbelieve someone as young as you couldhave such a huge impact on my life!’”The students’ effectiveness is not a

matter of hit-or miss; they have beentrained to do their jobs and trained well.According to Mark Marino, ExecutiveDirector of Health Leads Baltimore, “Allvolunteers undergo at least 16 hours ofpre-service training by Health Leadsstaff, social workers, physicians, lawyers,and community leaders to ensure theyhave the skills to serve clients in aneffective, culturally competent manner.Volunteers also participate in weekly on-campus ‘reflection sessions’ to deepentheir understanding of the health caresystem and the link between health andpoverty; to build a community of peerscommitted to tackling these issues; andto tie their work in the clinic to theircareer aspirations.”

Abell Salutes Mark Marino, Execu-tive Director of Health Leads Baltimore,all of Health Leads Baltimore staff, andall of the students from Johns Hopkins,Loyola University, and the University ofMaryland, Baltimore County who arehelping the Baltimore community “hitthe public health jackpot.”

ABELL SALUTEScontinued from page 1