Neighborhoods as Systems: Free Toolkit Helps Communities Create Lasting Change 

For years, communities across Greater Cincinnati and southwest Ohio have worked to address challenges such as hunger, housing instability, transportation barriers, and poor health outcomes. But according to Dr. Carley Riley, a physician and researcher at Cincinnati Children’s Hospital, lasting progress requires looking beyond individual problems and understanding the systems that produce them.  

That philosophy is at the heart of the Neighborhoods as Systems Toolkit. Developed through more than a decade of collaboration between residents, community organizations, Cincinnati Children’s and Design Impact, the toolkit offers a practical framework for neighborhood-led systems change.  

“Neighborhoods behave as systems,” Dr. Riley explained during a sit-down with Brick by Brick’s Emiko Moore. Housing, food access, safety, businesses and other factors are interconnected, she said, and together they shape the outcomes residents experience. Rather than treating symptoms, communities must understand and improve the underlying systems that generate those outcomes. 

According to Riley, one of the most important lessons was that community members possess expertise that institutions and organizations often cannot see on their own. By observing how families navigate social services, healthcare systems and other community resources, researchers gained valuable insights into where systems succeed and where they fail. The lived experiences of residents became a source of system-level knowledge.  

The result is a straightforward four-step process: Connect, Explore, Test and Sustain. The approach helps neighbors identify shared priorities, uncover the root causes behind persistent challenges, test small-scale solutions, and expand what works. Think of it as a repeatable way to organize neighborhood stakeholders around complex problems and create sustainable, community-led change.

Perhaps most importantly, the toolkit is designed to place decision-making power in the hands of residents themselves. 

“They’re the ones that are utilizing the tools and leading the conversation and ideating and making decisions,” Dr. Riley said. “We’ve essentially created the context within which people, neighbors use these tools themselves.” And that’s the point. Collective on-the-ground knowledge leading to collective action.

The approach has already influenced efforts in neighborhoods including Avondale, East Price Hill, Lower Price Hill, and the West End. In Avondale, residents partnered with local organizations to develop a mobile market (Last Mile Rescue) that brings free food directly into the neighborhood at locations chosen by residents. Community members also helped launch the Avondale Respite Center, a nonprofit that provides crisis nursery support for families. Both initiatives emerged from residents identifying needs and designing solutions themselves, according to Dr. Riley. 

Underlying the entire model is a belief that action creates hope. When residents see that their ideas can lead to measurable improvements, participation grows, new ideas emerge and momentum builds. The toolkit helps communities focus their energy on high-impact opportunities rather than activity for activity’s sake.  

For Dr. Riley, the ultimate goal is not simply solving individual problems. It is creating communities where everyone has the opportunity to thrive. 

“When all of the people who are living within that community have the ability, the promise, the opportunity to reach and live their best lives,” she said, “that’s when we thrive.”  

The Neighborhoods as Systems Toolkit is freely available to anyone. If your neighborhood is thinking about using it to tackle a challenge, we’d love to hear from you? Send us an email at brickbybrick@publicmediaconnect.org to share your progress or roadblocks, and how it’s helping you create a healthier, more equitable neighborhood from the ground up. 

Mark Lammers – Executive Producer

Mark is an award-winning storyteller, producer, and a native-Cincinnatian. As a fresh Ohio University graduate, he jumped into producing broadcast news with CBS affiliate KKTV in Colorado Springs, CO. Gaining insight over a half-decade, Mark then pivoted to production management, helping Amazon Studios produce and launch its first line of original streaming series in Los Angeles. From there, Mark and his wife Sheena (a fellow Cincinnatian) returned to the Queen City to start a family and serve as executive producer and director of local content for Public Media Connect, CET and Think^TV. Since joining the team, he’s earned numerous regional Emmy awards. Mark hopes this effort – to highlight solutions while contextualizing our social problems – will empower more of our neighbors to engage with each other to create a better future for us all.