A systems-level perspective to addressing health harming legal needs via a joint Health Equity Collective and MLP network approach"

项目总结 健康的不利社会决定因素(SDoH)对低收入者和社区的影响不成比例 一种颜色。专业知识和资源的多部门协调可以有效地针对这些不利的SDoH 通过创新和多样化的视角来满足需求；医疗法律就是这样一个例子 合作伙伴关系(MLP)，其中医疗机构与法律实体合作，以满足不利的社会需求 通过法律补救。因此，这些不利的社会需求被称为损害健康的法律需求 (HHLN)，因为它们依靠法律支持进行解决。虽然人们对MLP有很大的兴趣 临床上缺乏对实施效果及预测实施成功因素的研究 设置。此外，这些现有的实验研究都不是在#年南部地区进行的。 美国，因此在实施MLP时忽略了地理和文化背景。鉴于这种可获得性有限 为了支持有效性的研究，我们提出了一种系统级别的方法来探索患者- 知情的MLP干预解决UT内科医生登记的儿科家庭的HHLN 综合专科诊所。这种方法集成了社区声音(患者)的角度来识别生活 临床环境中可能阻碍筛查和护理协调过程的经验(主题)。 因此，我们将使用关键的线人访谈来定性地探索和确定影响 患者的治疗经验 在……上面 反馈 筛选和获取资源以满足不利的社会需求，并特别强调 可能影响MLP计划利用率以解决这些需求的因素(目标1)。然后我们将利用 从目标1到建立评估框架和协议，以评估覆盖范围、有效性、 采用、实施和维护现实世界的MLP干预(目标2a)。这项评估 框架将随后用于我们的准实验研究，以评估MLP的有效性和 影响去UT内科医生综合专科诊所的儿科家庭实施的因素(目标2b)。 项目的成功完成将有助于在各诊所实施MLP，制定更好地针对高危人群的战略 人口，以及提交R01申请，我们可以在那里评估MLP的有效性 干预并进一步检查MLP在大休斯顿地区诊所的扩展和实施 区域。 到目前为止，我的研究考察了人口、社会和背景因素对 低收入和少数群体的不良行为和健康相关后果。的指导作用 在K01机制的支持下，Sharma、Murphy、Liew和Huber博士将确保我继续获得 相关定性和定量方法、系统一级的知识和高级培训 干预措施和以社区为基础的参与性研究战略，为研究活动提供信息。

PROJECT SUMMARY Adverse social determinants of health (SDoH) disproportionately impact low-income and communities of color. The multisectoral alignment of expertise and resources can effectively target these adverse SDoH needs through innovation and diverse perspectives; and one such example is that of medical legal partnerships (MLPs) wherein healthcare institutions work with legal entities to address adverse social needs through legal remediation. These adverse social needs are thereby referred to as health harming legal needs (HHLNs) as they depend on legal support for resolution. While there has been great interest in MLP implementation, research on its efficacy and factors that predict implementation success is lacking in clinical settings. Furthermore, none of these existing experimental studies were conducted in the southern region of the U.S, thus omitting geographic and cultural contexts to MLP implementation. Given this limited availability of research in support of effectiveness, we propose a systems-level approach to explore the impact of a patient- informed MLP intervention that resolves HHLNs in pediatric families enrolled across UT Physicians multispecialty clinics. This approach integrates the community voice (patient) perspective to identify lived experiences (themes) within the clinic setting that may impede the screening and care coordination process. As such, we will use key informant interviews to qualitatively explore and identify themes that influence patients' experiences with on feedback screening and resource access for adverse social needs, with particular emphasis factors that may impact utilization of an MLP program to resolve these needs (Aim 1). We will then leverage from Aim 1 tobuild an evaluation framework and protocol for assessing the reach, effectiveness, adoption, implementation, and maintenance of a real world MLP intervention (Aim 2a). This evaluation framework will be subsequently utilized in our quasi-experimental study to assess MLP effectiveness and factors that impact implementation in pediatric families who visit UT Physicians multispecialty clinics (Aim 2b). Successful project completion will inform MLP implementation across clinics, strategies to better target at-risk populations, and the submission of an R01 application where we can assess the efficacy of an MLP intervention and further examine MLP expansion and implementation across clinics in the Greater Houston area. To date, my my research has examined the impact of demographic, social, and contextual factors on adverse behavioral and health-related outcomes among low-income and minority groups. The mentorship of Drs. Sharma, Murphy, Liaw, and Huber supported by this K01 mechanism will ensure that I continue to acquire knowledge and advanced training in relevant qualitative and quantitative methodologies, systems-level interventions, and community based participatory research strategies for informing research activities.