A systems-level perspective to addressing health-harming legal needs via a joint Health Coalition and MLP network approach - Non-medical drivers of health (NMDoH) such as food insecurity, unstable housing, lack of transportation, and restricted access to health-related services are strongly associated with poor health outcomes and are disproportionately concentrated in economically disadvantaged populations. Medical-legal partnerships (MLPs) represent a promising systems-level strategy to address these complex issues by embedding legal expertise within clinical settings to resolve health-harming legal needs (HHLNs). While there has been great interest in MLP implementation, research on its efficacy and factors that predict implementation success is lacking in clinical settings. To date, few studies have been conducted in the Southern U.S., where regional context may shape how MLPs are delivered and experienced. 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 screening and resource access for HHLNs, with particular emphasis on factors that may impact utilization of an MLP program to resolve these needs (Aim 1). We will then leverage feedback from Aim 1 to build 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 completion of this project will provide foundational data to inform future MLP implementation strategies, support care coordination efforts responsive to key NMDoH, and guide the submission of a competitive R01 trial evaluating MLP effectiveness in a broader pediatric population. Study findings will support system-level improvements in connecting patients to services that address both clinical and non-clinical contributors to health. My prior research has focused on the influence of demographic, contextual, and behavioral factors on health related outcomes in economically disadvantaged populations. Under the mentorship of Drs. Sharma, Murphy, Liaw, and Huber, this K01 award will support my continued training in qualitative and quantitative research methods, systems-oriented intervention design, and implementation science.
