What is Systems for Action?
Systems for Action (S4A) is a signature research program of the Robert Wood Johnson Foundation (RWJF) that builds a Culture of Health by rigorously testing new ways of connecting the nation’s fragmented medical, social, and public health systems. Health is shaped by a complex web of social, economic, and environmental conditions that extend far beyond the reach of the medical care system. S4A uses a wide research lens that includes and extends beyond the medical care and public health systems to incorporate social service systems such as housing, transportation, education, employment, food and nutrition assistance, child and family support, criminal and juvenile justice, and economic and community development. The national program office for the S4A program is based at the Department of Health Systems, Management and Policy at the Colorado School of Public Health, University of Colorado.
What types of projects are eligible under this Call for Proposals?
The S4A program funds rigorous scientific studies that are designed to evaluate the impact of initiatives that align medical, social, and public health systems. This latest CFP from the S4A program will fund scientific studies that focus on a specific type of system alignment problem: the wrong-pocket problem. Read the full CFP for more information about the wrong pocket problem and its potential solutions.
Achieving racial equity and health equity in America requires effective solutions to the wrong-pocket problem, a fundamental problem that confronts many attempts at meaningful cross-sector collaboration. This call for proposals (CFP) will provide funding for such solutions that allow collaborating organizations to equitably share in the costs and the benefits of multisector collaborative initiatives, and to share in the power and influence that govern these initiatives. The S4A program is particularly interested in studies that will evaluate proposed solutions that engage all three types of systems implicated in the S4A research agenda: 1) medical care; 2) public health; and 3) social services. Special consideration will be given to studies that meaningfully engage all three types of systems in the solution to the wrong-pocket problem. At a minimum, proposed studies must focus on a solution that meaningfully engages the social services system and one of the other two types of systems of interest, medical care, or public health. Proposals that focus purely on implementing a strategy, without a strong scientific approach for evaluating the implementation and/or impact of the strategy, will not be funded.
What types of studies are considered rigorous scientific studies?
This CFP will fund studies that evaluate the impact of a potential solution to a wrong-pocket problem that involves medical, social, and public health systems. To be considered scientifically rigorous, the study design and analytic approach must be sufficient to support inferences about the causal impact of the potential solution. Many different types of experimental and quasi-experimental research designs can be used to estimate causal effects. See for example: Shadish WR, Cook TD, and Campbell DT. Experimental and Quasi-Experimental Designs for Generalized Causal Inference, 2nd Edition. New York: Houghton Mifflin, 2001. Well-designed and validated simulation studies may also be in scope for this CFP. Studies must be designed to estimate the counterfactual – what would have happened in the absence of the proposed solution? Additionally, studies must be able to credibly rule out the possibility that other factors beyond the potential solution are responsible for producing the observed effects. Purely qualitative research designs, descriptive studies, exploratory studies, cross-sectional designs, uncontrolled pre-post studies, post-test only designs, and pilot studies are unlikely to satisfy these requirements.
Other study characteristics that determine the level of scientific rigor include: sample sizes and statistical power; validity and reliability of data sources and measures; representativeness and generalizability of study settings; appropriateness of comparison groups; and strength of analytic approaches to be used.
Can grant funding be used to implement the proposed solution to the wrong-pocket problem?
This CFP is not appropriate for applicants who primarily seek funding to implement their proposed solution. Because S4A is a research program, grantees are expected to use all or most of their grant funding to carry out the research study, rather than to implement the proposed solution. Applicants who propose to use part of their grant funding to support implementation may be at a competitive disadvantage relative to other applicants, for several reasons: (1) these applicants will have fewer resources available to carry out a scientifically rigorous research study; (2) these applicants will have greater difficulty demonstrating the feasibility of their proposed solution, because implementation will depend upon receipt of grant funding; and (3) these applicants will have greater difficulty demonstrating the sustainability of the proposed solution beyond the end of the grant period.
What is the wrong-pocket problem?
Systems that are designed to improve social and economic conditions—such as housing, transportation, education, income, and employment assistance; child and family supports; and legal and criminal justice services—are often disconnected from the medical services and public health programs tasked with improving health. Imbalances in power, information, and financial resources exist across medical, social, and public health systems, discouraging meaningful cross-sector collaboration and collective action. These circumstances give rise to a fundamental problem that confronts many attempts at meaningful cross-sector collaboration. The costs and benefits associated with a promising solution that requires multisector cooperation are not distributed evenly across participating organizations and systems, creating conflicting incentives for undertaking, scaling and sustaining the solution. This is the essence of the wrong-pocket problem such that implementation costs are drawn largely from one set of pockets, while benefits flow into alternative sets of pockets. An example is in providing “upstream” services that address social, behavioral, or environmental needs like housing, nutrition, financial assistance, education, child care, or legal aid—but the economic benefits flow largely “downstream” to funders of the medical care sector in the form of reduced and avoided health care costs from diseases and injuries prevented.
What are some examples of research questions that illustrate the types of wrong-pocket problems and solutions to be studied under this CFP?
What is the impact of a community-wide initiative in which a Medicare Advantage health plan works with local employers, community-based organizations, and others to finance community-based services that identify older adults experiencing food insecurity and/or social isolation and provide them with access to healthy foods and social supports? Reducing food insecurity and social isolation among older adults can significantly improve health and well-being and reduce medical care utilization, but health plans often do not share equitably in the costs of implementing these community-based services. One example of a solution to this problem is the Humana Bold Goal initiative implemented in Louisville, New Orleans, San Antonio, Knoxville, and several other cities across the United States.
What is the impact of a collaborative financing model that engages hospitals, health insurers, and local governments in helping to fund the expansion of affordable housing options for historically marginalized communities experiencing housing insecurity? Improved housing can improve health and reduce the need for costly medical care, but medical care providers and payers often do not share equitably in the costs of expanding housing options within communities. One example of a collaborative financing model to solve this problem is the Collaborative Approach to Public Goods Investments (CAPGI) developed by stakeholders at George Mason University, Urban Institute, and Altarum.
What is the impact of a cross-sector initiative that redirects resources from local law enforcement agencies to support community-based mental health services in order to avoid harmful and unnecessary interactions between police and persons experiencing mental health crises? Expanded access to mental health services can reduce the need for law enforcement to intervene with persons experiencing mental health crises, but law enforcement agencies often do not share equitably in the costs of implementing expanded mental health. One example of a solution to this problem is the CAHOOTS system operated by the City of Eugene, Oregon, local law enforcement, and the White Bird Clinic.
What is the impact of a shared funding model in which a Medicaid health plan and a network of pediatric practices help to finance and implement the delivery of early childhood education services for children at risk of exposure to trauma and adverse childhood experiences? Early childhood education can reduce child exposure to trauma and violence and mitigate the adverse health effects of exposure, but medical care providers and payers often do not share equitably in the costs of these educational services. One example of a solution to this problem is the Educare early childhood education model used in Chicago, Milwaukee, and several other locations across the United States.
What is health equity?
Health equity is achieved when everyone has the opportunity to live their healthiest life possible regardless of who they are, where they live, or how much money they make. Funded studies must focus on system alignment mechanisms that have the potential to improve health equity.
Applicants are encouraged to follow recommendations of the National Academy of Medicine regarding strategies for measuring health equity, available at: https://www.nap.edu/read/21899/chapter/5. Measures should quantify differences in health outcomes, risks, or determinants across key population subgroups of interest such as those based on race, ethnicity, gender, socioeconomic status, disability status, geography, or other subgroups that experience differences in opportunity, social position or power.
Should projects focus on all three sectors (medical, social, and public health) or can you focus on only two sectors for alignment?
We are particularly interested in studies that will evaluate proposed solutions that engage all three types of systems implicated in the S4A research agenda: 1) medical care; 2) public health; and 3) social services. Special consideration will be given to studies that meaningfully engage all three types of systems in the solution to the wrong-pocket problem. At a minimum, proposed studies must focus on a solution that meaningfully engages the social services system and one of the other two types of systems of interest, medical care, or public health.
What is the deadline for submitting proposals?
Proposals must be submitted through the RWJF online system by June 9, 2021 at 3:00pm ET. Late applications will not be permitted. You will be required to register at MYRWJF at https://my.rwjf.org before you begin the application process.
What is the deadline for submitting a Letter of Intent (LOI)? If I missed the deadline can I submit a full proposal?
The deadline for LOIs is April 30th, 2021. LOIs are not required in order to submit a full proposal and there will be no extension.
To submit your full application, register on the MYRWJF site at https://my.rwjf.org Proposals and submit by June 9, 2021 at 3:00pm ET. Late applications will not be permitted.
What is the duration and amount per grant awarded?
Applicants may apply for awards of up to 36 months in duration with up to $500,000 in total funding from RWJF.
What would or would not be considered a system?
Every program, service or intervention is implemented through a delivery system. A delivery system is the constellation of organizations, people, policies, and resources that allow the program to be implemented for members of the target population. Similarly, a financing system is the constellation of financial resources, funding mechanisms, funders, and payment policies that support implementation of a program or service. Applicants should articulate clearly how they define the delivery and/or financing systems to be aligned through their proposed research.
What organizations and activities are part of the social service sector?
We define the social service sector to include any organization, program or service that works to address fundamental human needs in the community and promote social well-being. This sector includes organizations and programs that provide education, housing, income support, employment assistance, diversity and inclusion initiatives, food assistance, transportation, child and youth development, recreation and physical activity, legal assistance, disability support services, violence prevention, arts and cultural programming, criminal justice and juvenile justice services, and community and economic development.
What organizations and activities are part of the medical care sector?
We define the medical sector to include any organization, program, or service that helps individuals obtain access to clinical services that prevent, treat, or manage diseases and injuries, including services for physical health conditions, mental health conditions, substance abuse, and developmental disabilities. This sector includes the providers, purchasers, and payers of these services as well as the suppliers of associated products and technologies, such as pharmaceutical products and health information technologies.
What organizations and activities are part of the public health sector?
We define the public health sector to include any organization, program or activity that works to create the conditions in which people can live healthy lives, including activities to prevent disease and injury and promote health for the population at large. This sector includes governmental public health agencies working at local, state, and federal levels, as well as nongovernmental organizations that pursue a public health mission.
What types of organizations are eligible for funding?
Applicants must be either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code and are not private foundations or non-functionally integrated Type Ill supporting organizations. Applicant organizations must be based in the United States or its territories. Awards will be made to organizations, not to individuals. Multi-organizational consortia are encouraged to apply if a single eligible organization is designated as the primary applicant responsible for maintaining consortium agreements with other participating organizations.
Do the eligibility requirements for applicant organizations also apply to partners?
No, but subcontracts or partner relationships with for-profit entities or entities based outside the United States may require additional financial and/or legal due diligence.
Can an organization submit multiple proposals?
Yes, an organization may submit more than one proposal as long as each proposal submitted is distinct in terms of both project and research team.
Can I apply for this opportunity if I have previously been or am currently funded by RWJF?
Yes, previously or currently funded RWJF grantees are eligible to apply for this funding opportunity, but the proposed project must be different from previously funded work.
How will my proposal be evaluated?
Applicants will submit narrative proposals containing the project rationale, significance, approach and information about the project’s budget, staffing, collaborators, and institutional support. Applications will be reviewed by a review panel that includes members of the S4A National Advisory Committee, S4A staff, Robert Wood Johnson Foundation staff, and subject matter experts. Applicants are encouraged to submit a one-page letter of intent (LOI) providing a preliminary title, a brief description of the proposed research, and a listing of the participating investigators and institutions. This LOI is not binding and not required, but it ensures that the program office is able to recruit reviewers with appropriate subject matter expertise to review your application thoroughly. See the CFP for the specific review criteria.
What type of investigators should apply?
The proposed research team should include individuals with theoretical, methodological, and operational expertise that is directly relevant to the wrong-pocket problem of interest, the proposed solution, and the proposed scientific approach. Funded studies should have research teams that include expertise in each of the types of systems that are engaged in the proposed solution, including social services, medical care, and/or public health. Teams should include individuals with relevant community-based expertise, knowledge of Black, Indigenous, and other communities of color, and practical experience with leading systems change.
If I am not chosen for this funding opportunity can I apply for another RWJF grant opportunity?
Yes, interested applicants may apply for other RWJF grants. You must actively submit to other opportunities in which you are interested as proposals declined by S4A will not automatically be considered by other programs.
How can I tell if I am applying to the correct RWJF program?
Within the Foundation’s Research, Evaluation, and Learning initiative, RWJF funds a range of research to expand understanding of what will allow everyone in our nation to have an equitable opportunity to live the healthiest life possible and which types of interventions may have greatest potential for impact. Its four signature research programs, including Systems for Action, work to identify root causes of inequitable health outcomes in America and potential solutions that engage multiple sectors and disciplines.
|The Systems for Action (S4A) program, based at the Colorado School of Public Health, University of Colorado, within the Health Systems, Management & Policy Department, conducts rigorous research on ways to align, coordinate, and integrate the many delivery and financing systems that promote health and well-being on a population-wide basis, including medical, public health, and social services and supports.|
|The Policies for Action (P4A) program, based at the Urban Institute, investigates how policies, laws, regulatory changes, systems interventions, and community dynamics can be leveraged to support population health, well-being, and equity. P4A is building a robust, actionable evidence base on how these critical levers can advance a Culture of Health, with a goal of delivering these data and insights to key policymakers, community leaders, and other change agents. (Call for Proposals is currently closed.)|
|The Evidence for Action (E4A) program, based at the University of California, San Francisco, awards grants to encourage and support innovative, rigorous research on the impact of programs, policies, and partnerships on health and well-being, with a particular focus on research that will help advance health equity. It is the broadest of the three programs – it does not have a formal research agenda, and it funds across all areas of the Culture of Health Action Framework. Learn more about E4A’s rolling application process here.|
|The Health Data for Action (HD4A) program links researchers with valuable health data, and funding research to help answer important, policy-relevant questions.|
To learn more about additional current and upcoming RWJF funding opportunities of interest visit the Foundation’s Funding Opportunities page.