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

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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.