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

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.