Addressing durable health disparities through critical time legal interventions in medically underserved Latinx and migrant communities in the United States.

项目总结 交叉流行病，例如心血管疾病(例如，高血压)，传染病(例如， 新冠肺炎)、代谢疾病(如糖尿病)、精神健康和物质使用障碍(如 发生酒精使用障碍和抑郁)在历史上考验了医疗保健系统的局限性 美国的拉丁裔和移民人口等边缘化社区。早期发现和 在医疗服务不足的社区，上述情况的严重性因系统性障碍而加剧 初级保健和拘留。在这项研究中，我们提出，在初级保健中提供法律服务可以 通过解决法律需求(如医疗保险障碍、 医疗、住房安全、就业稳定和其他法律需要)，这可能会扰乱对患者的护理。 这项拟议的研究由SBU社会福利学院和SBU权力制度变革中心牵头， 与GWU公共卫生学院吉尔-勒博维奇加勒比社区卫生中心和 拉丁美洲、波多黎各大学社会决定因素中心、国家医学法律中心 合作伙伴关系，UCF医学院的实施科学实验室，以及六个联邦合格的卫生中心； 将准确地检查法律服务对医疗服务不足的初级保健结果的影响 社区。我们将进行一项采用整群随机设计的混合型II型有效性实施试验 在佛罗里达州奥兰多、纽约/长岛和圣胡安的6个联邦合格健康中心(FQHC)中，PR至 测试关键时间介入医疗法律伙伴关系(CTI-MLP)方法与 关心。三个初级保健中心将接受CTI-MLP办法，其中包括提供法律援助和能力建设。 通过面向团队的法律支持。其他三间护养院将接受法律教育和提高认识，包括 关于基于社区的法律组织的信息。在12个月的时间里，团队将收集(1) 患者的健康和功能，包括总体身体健康、心理健康、社会健康、疼痛、疲劳和 总体感知生活质量；(2)关于法律需求和风险因素的数据；(3)纵向患者临床结果 (n=960)；(4)FQHC工作人员(N=180)和诊所一级指标，包括提供者-患者沟通和 为继续执行和可持续性做好准备。我们将组建一个拉丁裔和移民社区 咨询委员会和具有医疗-法律伙伴关系专业知识的科学顾问委员会。积极参与将 确保将我们的调查结果有效地转化和传播到实践中。推出新的医疗补助模式 新出现的为一些社会护理提供补偿的州政府官员也可以利用数据来考虑 扩大医疗补助服务，包括协调和提供社会和法律服务。完成 该项目的实施将产生一套创新的、以证据为基础的干预方案，以改善 高度脆弱的社区。

PROJECT SUMMARY Intersecting epidemics such as cardio-vascular conditions (e.g., hypertension), communicable diseases (e.g., COVID-19, HIV), metabolic conditions (e.g., diabetes), mental health and substance use disorders (e.g., co- occurring alcohol use disorder and depression) have tested the limits of healthcare systems in historically marginalized communities such as Latinx and migrant populations in the United States. The early detection and severity of the above conditions in medically underserved communities are aggravated by systemic barriers to primary care and detention. In this study, we proposed that providing legal services within primary care can enhance healthcare delivery efficiency through addressing legal needs (such as barriers to health insurance, medical treatments, housing safety, employment stability, and other legal needs) that can disrupt care to patients. The proposed study, led by the SBU School of Social Welfare and SBU Center for Changing Systems of Power, together with the GWU School of Public Health's Gill-Lebovic Center for Community Health in the Caribbean and Latin America, the University of Puerto Rico's Social Determinants Center, the National Center for Medical Legal Partnerships, UCF School of Medicine's Implementation Science Lab, and six federally qualified health centers; will precisely examine the effects of legal services on primary care outcomes for medically underserved communities. We will conduct a hybrid type II effectiveness-implementation trial with a cluster randomized design in 6 federally qualified health centers (FQHCs) in Orlando, FL, New York/Long Island, NY and San Juan, PR to test a Critical-time Intervention Medical Legal Partnership (CTI-MLP) approach compared to the standard of care. Three FQHCs will receive a CTI-MLP approach that includes provision of legal aid and capacity building through team-facing legal support. The other three FQHCs will receive legal education and awareness, including information about community-based legal organizations. Over a 12-month period, the team will collect (1) patients' health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life; (2) data on legal needs and risk factors (3) longitudinal patient clinical outcomes (N=960); and (4) FQHC staff (N=180) and clinic-level indicators, including provider-patient communication and readiness for continued implementation and sustainability. We will assemble a Latinx and migrant community advisory board and a scientific advisory board with medical-legal partnership expertise. Active engagement will ensure the effective translation and dissemination of our findings into practice. With new Medicaid models emerging that offer reimbursement for some social care provision, state officials can also use data to consider expansion of Medicaid services to include the coordination and provision of social and legal services. Completion of this project will result in an innovative, evidence-based intervention package to improve health outcomes for highly vulnerable communities.