In 2016 Health Research for Action collaborated with Alameda County agencies to reduce childhood asthma disparities among Medi-Cal patients. HRA environmental health researcher Jason Su
and principal investigators Linda Neuhauser
and Len Syme
have been part of the team that is improving improve the county's prevention and early-intervention efforts and evaluating the results.
This work has been supported by a new type of grant, called "Pay for Success." With the Pay for Success model, investors provide funds for social services (usually activities aimed at prevention) up front. The desired results of the grantee program are defined up front as well. If the desired results are achieved, the investors are paid back, with a small return on their investment. Programs funded by Pay for Success grants are expected to result in cost savings (such as fewer emergency room visits for asthma attacks), which can be used to repay investors. If the program does not achieve the desired results, the grant recipient does not have to repay the investors.
Alameda County is using a Pay for Success grant to expand its Healthy Homes and Asthma Start programs. Healthy Homes does in-home evaluations for asthma risk factors and helps families remove asthma triggers from their homes. The Asthma Start program provides education and support to help families control children's asthma. Asthma Start objectives include increasing families' knowledge about asthma and changing behaviors (such as smoking inside) to reduce asthma triggers.
The HRA team has advised the county agencies on ways to enhance the intervention, monitor indoor air quality, and evaluate the program results. The evaluation includes measuring before-and-after changes in participants' asthma knowledge and behaviors. It also measures reductions in in-home environmental triggers, as well as emergency department visits, hospitalizations, and related healthcare costs.