Individual Research Projects

About the Projects

Systems for Action (S4A) is a program of RWJF that aims to discover and apply new evidence about ways of aligning the delivery and financing systems that support a Culture of Health. Based at the University of Kentucky College of Public Health, S4A seeks to identify system-level strategies for enhancing the reach, quality, efficiency, and equity of services and supports that promote health and well-being on a population-wide basis.
Investigators are testing innovative ways of aligning the delivery and financing systems for multiple services, with a focus on the health and economic outcomes that result. Research findings will shape future directions in health and social policy while informing clinical and administrative practices used by the professionals that work in these diverse but inter-related sectors.

Click here to dowloand a one-page flyer about the IRPs.















Housing for Health: Assessing the Cross-Sector Impacts of Providing Permanent Supportive Housing to Homeless High Utilizers of Health Care Services

Principal Investigators: Ricardo Basurto Davila, PhD, MS, Los Angeles County Department of Public Health & Corrin Buchanan, MPP, Los Angeles County Department of Health Services

Homeless individuals experience a higher risk for mortality, chronic illness and mental health disorders, and are often high utilizers of healthcare. The Housing for Health (HFH) initiative, created in 2012 by the Los Angeles County Department of Health Services (DHS), is designed to reduce homelessness and inappropriate use of expensive health care resources, and improve health outcomes for this vulnerable population. Homeless individuals who are high utilizers of medical services are referred to permanent supportive housing (PHS) and intensive case management services, and subsequently to benefits and services provided by agencies in multiple sectors, including substance use treatment services. To evaluate this novel mechanism for integrating the delivery and financing systems for housing, medical care, and public health services, the principal investigators are assessing the HFH cross-sector impacts and organizational and financing issues to explore:

  • the effectiveness of HFH and other housing models on client referrals to services for which they are eligible in the housing and other sectors;
  • the impact of HFH on housing performance indicators, service utilization, and costs across sectors;
  • whether linkages of HFH clients to other sectors create synergies, leading to system-wide improved outcomes and lower costs; and
  • whether HFH’s cross-sector impacts reduce health inequities by improving quality of care received and health outcomes among its most vulnerable clients.










The Impact of Integrating Behavioral Health with Temporary Assistance for Needy Families to Build a Culture of Health across Two-Generations

Principal Investigators: Mariana Chilton, PhD, MPH, and Sandra Bloom, MD, Drexel University Dornsife School of Public Health

The prolonged activation of stress response systems among children responding to adversity such as homelessness, hunger, or neglect, is a predictor of poor health and continued poverty among low-income families. To study the health and economic impacts and systems implications of integrated services provided by the Pennsylvania Department of Human Services and Drexel University’s Center for Hunger-Free Communities, the principal investigators are evaluating the Building Wealth and Health Network (The Network) intervention, designed to reduce health inequities by aligning Medicaid coverage for behavioral health services and Temporary Assistance for Needy Families (TANF) education and training services. This evaluation will:

  • assess the effects of trauma-informed peer support built into education and training on health and economic security for participants in the Network;
  • identify cost savings to both TANF and Medicaid to build a case for linking these service systems; and
  • engage low-income caregivers, state human services officials, and key decision-makers in identifying ways to improve support systems to promote a Culture of Health within anti-poverty programming.








Testing of a Community Complex Care Response Team to Improve Geriatric Public Health Outcomes

Principal Investigator: Carolyn E. Ziminski Pickering, PhD, MSN, BSN, RN, Michigan State University

Elder abuse and neglect (EA/N) is a public health and safety epidemic with impacts in emergency department utilization, nursing home placement, mortality, and financial losses. Vulnerability has been shown to be highly correlated with EA/N victimization, yet research is lacking on interventions aimed at decreasing vulnerability. The principal investigators of this study are reviewing the impact of a primary prevention strategy for EA/N victimization: the community complex care response team (CCRT) intervention. The CCRT intervention is a collaboration of three community agencies that provide 61 services across the medical care, public health and social and community services and support sectors and is evaluated by:

  • examining the impact of coordinated multi-sector service delivery offered by the CCCRT on two outcomes: EA/N and emergency department utilization;
  • exploring which institutions are best positioned to perform integrator roles in connecting vulnerable older adults to needed services and supports provided by the CCCRT, and
  • identifying implementation and translational issues of data sharing and storage across health and human service sectors.









Implementing a Culture of Health among Delaware's Probation Population

Principal Investigators: Daniel J. O’Connell, PhD, & Christine Visher, PhD
University of Delaware

Individuals under the U.S. probation system have higher incidences of health conditions including substance abuse and mental illness and are less likely to access health care and other social services, such as education, transportation, employment, and housing, than those not involved in the system. To investigate the process and impact of implementing a multi-agency “Culture of Health” team in the Delaware Department of Probation, the study combines the efforts of multiple agencies working across traditionally siloed systems, including the Departments of Health and Human Services, Labor, Housing, Education, and Correction. To evaluate this novel mechanism for integrating the delivery and financing systems for criminal justice probation services, medical care, employment, housing and other support services for justice-involved adults the principal investigators are:

  • testing the efficacy of using the Change Team approach to leverage different financing systems (e.g., Medicaid and private insurance) and service coordination (e.g., health care, education, and job training), and
  • providing education, screening, testing and referrals for  follow-up services to the probation population.