New Studies Test Strategies for Meeting Health and Social Needs During the COVID-19 Pandemic

AURORA, CO—Negative consequences of the COVID-19 pandemic will be felt in communities well after the spread of the virus is brought under control. The resulting economic disruption may increase social and health needs, exacerbating pre-existing inequities across the country. Greater alignment across health and social services is necessary for any meaningful recovery, but more research is needed to determine best practices.

Systems for Action, a national program office of the Robert Wood Johnson Foundation, is pleased to announce five recipients of new grants totaling $1 million in supplemental research awards. The new funding will allow researchers to examine the needs, opportunities and constraints created by the COVID-19 pandemic by extending studies that test promising approaches for aligning delivery and finance systems for medical, social, and public health services.

“The pandemic has deepened many social and health inequities that exist across American society, and unless we take action these effects will persist long after the virus is gone,” said Dr. Glen Mays, professor and chair of the department of Health Systems, Management and Policy at the Colorado School of Public Health and director of the Systems for Action program office. “These new studies will help identify how best to coordinate health and social services so that we reduce inequities as bring the pandemic to an end.”  

The new studies will use rigorous scientific methods to test approaches to coordinating these systems during the pandemic. Key communities of focus include people experiencing homelessness, Medicaid recipients with complex needs, and children. Studies also assess organizational capacity to meet the needs of residents, and county-level patterns in controlling the pandemic. “In an era of tightening budgets and growing needs, new research is critical to identify what solutions for aligning systems are most effective, for which populations, under what circumstances and at what cost,” said Dr. Mays.

Descriptions of the new studies are below:

Changes in Capacity to Absorb Clinical-to-Community Referrals During the COVID-19 Pandemic 

[Lead Institution: The Glasser/Schoenbaum Human Services Center]

This study assesses the capacity of community social services organizations and their partners to meet the needs of new clients identified through emerging social determinants of health (SDoH) screening and referral tools used by medical providers during the COVID-19 pandemic. In a previous study, researchers developed a method for assessing the capacity of social service organizations to accommodate referrals from medical providers. In this follow-up study, a team based at The Glasser/Schoenbaum Human Services Center and Visible Networks Lab use social network analysis, secondary data, and qualitative interviews to explore how clinical-community referral networks and referral patterns have changed during the COVID-19 pandemic, and how these changes may affect service delivery and outcomes for community residents. Findings will guide efforts to strengthen the capacity of communities to meet the health and social needs of their residents.


Using Whole Person Care to Coordinate Health and Social Services for Medicaid Populations During the COVID-19 Pandemic

[Lead Institution: University of California, Los Angeles]

This study evaluates the effectiveness of California’s Whole Person Care (WPC) initiative in coordinating health and social services for Medicaid beneficiaries with complex needs during the COVID-19 pandemic. Projects underway in 26 counties engage Medicaid health plans, medical providers, mental health agencies, social service organizations, and public health agencies in collaborative models of care and payment that target specific population groups with complex needs in each county, including people experiencing homelessness, those transitioning from incarceration, and patients with multiple chronic medical conditions.  Using a quasi-experimental research design, researchers assess changes in collaborative community networks, service delivery patterns, and patient outcomes for program participants and matched comparison groups across 26 county-level projects before and after the onset of the COVID-19 pandemic.  The study analyzes data from network surveys, Medicaid claims data, and key-informant interviews to assess program effectiveness from multiple perspectives.  Researchers from the University of California, Los Angeles and University of California, Berkeley are collaborating with the California Department of Health Care Services to conduct the study. 


Effectiveness of Homeless Service Networks in Coordinating Services During COVID-19

[Lead Institution: University of North Texas]

This study assesses the effectiveness of Continuum of Care homeless service networks (CoCs) in addressing health and social service needs created by the COVID-19 pandemic for populations experiencing homelessness. CoCs use cross-sectoral collaborations to integrate delivery of medical care, public health and social services for people experiencing homelessness. This study uses case studies, national survey data of CoC networks, and secondary data analysis to compare previous performance to new evidence of the successes and challenges CoC homeless service networks experience during the pandemic. Researchers from the University of North Texas and the University of Utah will collaborate to complete the study. Findings will be used to understand the effects of the pandemic on CoC homeless service networks and the effectiveness of the networks in achieving health equity during COVID-19.


Effectiveness of Early Childhood Development Partnerships in Addressing Pediatric Health and Social Needs during the COVID-19 Pandemic 

[Lead Institution: New York University]

This study evaluates the effectiveness of multi-sector Partnerships for Early Childhood Development (PECD) in maintaining social needs screening, referral, and service delivery for children during the COVID-19 pandemic in New York City. PECD is an initiative that provides funding and guidance to help pediatric primary care practices partner with community-based social service organizations to address the social needs of children and families. The study uses clinical and administrative data on screening and referral patterns from 4 PECD partnerships serving more than 8000 families, together with key informant interviews with service providers and focus groups with parents, to examine the effectiveness of partnership activities in addressing child health and social needs. Findings will identify how preexisting and emergent partnerships have changed in response to the pandemic, and how these changes have influenced the resiliency and sustainability of services needed by children and families. Researchers at New York University are collaborating with clinical and community partners in the PECD collaborative to complete the study.


Multi-Dimensional COVID-19 Control in US: Identifying Counties with High and Low Levels of Success

[Lead Institution: Johns Hopkins University]

This study examines how the allocation of resources across medical, social, and public health services at the county level influences the relative success in controlling the progression of the COVID-19 pandemic. The project focuses on resource allocation decisions across sectors as a collective impact process that may influence the ability of organizations to cooperate effectively across sectors in responding to the pandemic. Using a positive deviance modelling approach, the study analyzes national longitudinal data from the U.S. Census of Governments, the National Longitudinal Survey of Public Health Systems, and the COVID-19 Tracking Project, together with qualitative stakeholder interviews, to identify the best and worst performing states and counties in controlling pandemic progression, and to explore the contributions of resource allocation patterns. Researchers from Johns Hopkins University will collaborate with the National Association of County and City Health Officials (NACCHO), representatives of public health, medical care, and social services sectors to complete the study. Findings will be used to inform counties on how spending allocations for medical, social, and public health services can improve population health during a pandemic.

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About Systems for Action: Systems for Action, a research program of the Robert Wood Johnson Foundation, is focused on discovering new ways of improving health and health equity by helping medical, social, and public health delivery systems work better together. The program now includes more than 25 individual studies underway across the U.S. that are testing a broad array of strategies for system alignment, including novel financing arrangements, alternative staffing models, new information and communication technologies, and collaborative governance and decision-making structures. Systems for Action is based in the Department of Health Systems, Management and Policy at the Colorado School of Public Health in Aurora, Colorado.

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Author: 
Chris Lyttle, JD