Research at the NYU-CUNY Prevention Research Center (NYU-CUNY PRC), a partnership between NYU Langone and the CUNY Graduate School of Public Health and Health Policy, advances the study of innovative combinations of community- and clinic-based interventions for improved linkage to preventive care and chronic disease prevention and management.

In our third consecutive five-year funding cycle, spanning 2019 to 2024, we are accelerating the translation of evidence-based and innovative programs to increase access to care and disrupt the cycle of health disparities among hard-to-reach populations from socially disadvantaged backgrounds. Our active core research projects include evaluations of the New York City Health Justice Network and the Harlem Health Advocacy Partners program.

Our completed core research projects include Implementing Million Hearts for Provider and Community Transformation (Project IMPACT) and Reaching Immigrants through Community Empowerment (Project RICE).

Program Evaluation of the New York City Health Justice Network

Two parallel evaluation studies are underway. In the first study, led by Maria R. Khan, PhD, MPH, and Nadia S. Islam, PhD, our team is helping to evaluate a novel community health worker–facilitated, trauma-informed intervention, the New York City Health Justice Network (NYC HJN), to improve the health of justice-involved populations. In a second study, led by Terry T.-K. Huang, PhD, MPH, MBA, and Dr. Khan, and with separate funding from the District Attorney of New York, our team is examining the impact of NYC HJN on reduced criminal justice involvement. These collaborations build on our established partnership with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and new partnerships with city and state criminal justice agencies.

Health-Related Needs of People with a History of Justice Involvement

The United States has the largest correctional population in the world, with 2.1 million individuals held in jail or prison at any given time and 11 million jail incarcerations each year. Incarceration disproportionately impacts racial and ethnic minority groups, which has lasting effects on their families and communities.

Criminal justice involvement is a social determinant of health that intersects with racism, poverty, trauma, and psychiatric symptoms to perpetuate disproportionate health disparities and disease risk in minority communities. Given the complex role of social determinants, strategies that link primary care and social services using a trauma-informed framework by trusted sources, such as community health workers (CHWs), have the potential to reduce health disparities in people with a history of justice involvement (PWJI).

Evaluation of a Municipal Practice-Based Community-Clinical Linkage Model

In 2018, the NYC DOHMH introduced the NYC HJN, a new CHW-facilitated practice-based community–clinical linkage program that extends the agency’s growing portfolio of municipally funded CHW programs to address the health-related needs of PWJI. This multisector program involves a partnership with the NYC DOHMH, Federally Qualified Health Centers, and community-based organizations, including three primary care clinics—the Institute for Family Health, Community Healthcare Network, and NYC Health + Hospitals/Sydenham. We are also working with three re-entry support service organizations, The Fortune Society, Osborne Association, and the Center for Innovation’s Harlem Community Justice Center.

The NYC HJN expands on current national-level models to deeply integrate CHWs with a history of working with people who have been incarcerated into primary care clinics and community-based organizations and implement trauma-informed care in both settings.

Funding from the District Attorney of New York to NYC DOHMH supports the program’s implementation over three years beginning in 2019, with the long-term goal of scaling this public health practice across New York City. The NYU-CUNY PRC and the NYC DOHMH collaborate with a unique multisectoral network of organizations on the evaluation including NYU Langone’s Health Evaluation and Analytics Lab (HEAL), the NYC Department of Correction and the NYC Mayor’s Office of Criminal Justice. We are also collaborating with the New York State Department of Corrections and Community Supervision on an additional study focused on criminal justice outcomes.

New York City Health Justice Network Health Evaluation Aims

Our specific health evaluation is intended to achieve the following aims:

• determine program effectiveness in improving primary care engagement and medication adherence, using New York State Medicaid claims data housed by HEAL
• determine program effectiveness in reducing acute care utilization (emergency department visits) at 6 and 12 months post-enrollment
• assess barriers and facilitators to adoption, fidelity, and maintenance of NYC HJN and identify organizational factors influencing implementation
• evaluate the sustainability and scalability of NYC HJN within applied practice settings

New York City Health Justice Network Criminal Justice Evaluation Aims

Our justice evaluation specifically includes the following three aims:

• investigate associations between NYC HJN program participation and risk of recidivism at 6- and 12-months post-enrollment, and whether associations vary by participant factors
• examine NYC HJN program factors, such as recruitment, CHW interactions, service linkage and participant goal factors, that most strongly protective against recidivism
• explore participant experiences in the NYC HJN in a qualitative study

Evaluating this public health program, sponsored as part of the ongoing effort in New York regarding criminal justice reform and spearheaded by one of the nation’s leading municipal health departments, is a unique opportunity to address an understudied root cause of health disparities and to improve health for vulnerable communities.

Harlem Health Advocacy Partners Program Evaluation

Launched in 2014 through the New York City Mayor’s Office, the Harlem Health Advocacy Partnership (HHAP) is a place-based initiative that seeks to improve the health outcomes of New York City Housing Authority (NYCHA) residents in East and Central Harlem by connecting residents to CHWs and health advocates. The intervention, a partnership among the NYC DOHMH, NYCHA, community-based organizations, and the NYU-CUNY PRC, aims to reduce the proportion of residents with uncontrolled diabetes, hypertension, or asthma, while also activating the community to develop broad wellness and prevention capacity.

With Lorna E. Thorpe, PhD, MPH, serving as principal investigator, our center plays a key role in evaluating and supporting this NYC DOHMH–led initiative. The HHAP evaluation includes two parts: a community needs assessment conducted before the intervention to inform its design; and a longitudinal component to assess the impact of the intervention on individual behaviors, self-efficacy, and health outcomes.

The community needs assessment, “Launching a Neighborhood-Based Community Health Worker Initiative,” is publicly accessible as part of the HHAP’s Additional Resources. We also developed an original CHW toolkit for HHAP, which can be used to fit the needs of other CHW programs.