Late spring of last year, Gina received a phone call that her daughter Bianca had been admitted to the University of Chicago Medicine Trauma Center. Someone close to Bianca had put her in danger, shooting her multiple times. She was in critical condition and fighting for her life.
Amid the chaos, a coordinator from the trauma center’s violence recovery program provided Gina’s family with resources for patients who had suffered violent injuries, including information about survivor services and financial assistance programs. The coordinator also checked in with them about a newly formed partnership between the hospital and Legal Aid Chicago, a nonprofit that provides free civil legal services to people in Cook County.
The partnership, known as Recovery Legal Care, began in late 2022 and provides patients with legal assistance for social and economic needs, such as accessing public benefits. The goal is to break down barriers that families face after a violent injury and provide them with access to benefits and resources that can help improve their long-term health outcomes. Navigating the bureaucratic and paperwork process to obtain these resources is complex, and legal assistance is sometimes necessary to access them and appeal any denials.
“Legal services are expensive,” Gina said. “If you come from a financially struggling family, from a low-income family, and you don’t have the money to do legal work, you’re completely excluded.” (TRESS agreed to refer to Gina and Bianca by pseudonyms to allow them to speak openly without fear of retaliation.)
Bianca survived, but she was physically disabled and unable to work. She applied for disability benefits, but more than a year later, approval is still pending. In addition to her special needs, Bianca’s child also has a physical and developmental disability. To help, the Medical-Legal Partnership obtained disability benefits for her child, resolved a health insurance issue that prevented access to prescription medications, helped Bianca obtain Temporary Assistance for Needy Families (TANIF) benefits, and filed paperwork to protect her physical safety.
Partnership coordinators are still analyzing the data collected over the course of a full year, but so far the program has helped the majority of participants access benefits they were previously unaware of or had not received. In addition to filling a legal advocacy gap, the program has provided a new standard of care for patients injured by gun violence.
Gina said receiving help while her family was dealing with her daughter's injuries was a relief. Without the program, her family wouldn't have realized some of the benefits they are now experiencing. “It's so helpful because they'll see and say things you wouldn't think of, because you're dealing with a stressful situation,” Gina said. “It's helpful to have someone with a level head behind you.”
The programme breaks down barriers to legal, social and economic needs.
The idea for Recovery Legal Care first emerged in early 2021, three years after the University of Chicago School of Medicine launched its Level 1 Adult Trauma Center and Violence Recovery Program. Trauma surgeon Dr. Tanya Zachrisson and internal medicine physician Dr. Elizabeth Tong received feedback from their patients that they also faced social and economic concerns in addition to medical needs. The doctors realized that if they didn’t address those needs, their patients were more likely to return to the hospital with new gun injuries.
But referrals to resources weren’t enough, and Zachrisson, the program’s principal investigator, and Tong, a co-investigator, created a medical-legal partnership with Legal Aid Chicago to ensure patients got the legal help they needed. After receiving initial funding from the Office of Juvenile Delinquency and subsequent funding from the National Institutes of Health, program coordinators began screening patients for “health-damaging legal needs” in November 2022. These include any issues that negatively impact a person’s health and quality of life, including income, housing, and employment. Once those needs are identified, participants are referred to a civil law attorney who can help them.
During the first year of operation, 366 patients were screened, and more than 97% had at least one legal need that harmed their health. Nearly 87% had more than one legal need. The majority of these needs were related to public benefits that the patients were not receiving.
“It’s been really rewarding to see patients get what they deserve, especially after going through something really traumatic,” said Rhea Pillay, project coordinator for the program. In her role, Pillay makes initial contact with patients at their bedsides, conducts legal needs assessments, and evaluates data.
To be eligible for the program, patients must have been admitted to the University of Chicago Medicine Trauma Center for a violent injury, such as a gunshot wound, and be at least 14 years old. Citizenship status and criminal record do not affect eligibility. Instead, a legal referral may also be provided for assistance with immigration and record expungement issues.
Trauma centers serve patients who don’t typically interact with the health care system and who are in dire need of economic and legal support, Tong said. About 84 percent of the program’s participants were men and 85 percent were black.
“There are all these structural barriers that are a legacy of racism over the years, and those barriers lead to people needing a lot of resources that weren’t really created for them but are necessary,” Tong said. “They are rights that they should be receiving.”
In addition to navigating complex applications and facing language barriers to receive assistance, Black and brown communities have historically been denied benefits or disproportionately penalized for not following program requirements. Unequal access to services exacerbates health disparities. Studies have shown that safety net programs that increase household incomes are associated with improved health.
The goal, Pillay said, is to provide comprehensive care not only to the injured person, but to their entire family. She shared the story of a person who was paralyzed from a gunshot wound and through the program received home health care services, including wheelchair access. In addition, the legal team appealed the removal of the patient’s mother’s food assistance benefits and was able to secure them back with an additional monthly increase of more than $500.
Addressing Gun Violence with Public Health Solutions
As a trauma surgeon, Zachrison sees firsthand the impact of gun violence on the community surrounding the University of Chicago Hospital, and said much of the gun violence is rooted in racial and economic disparities. “If we eliminate structural violence, will that eliminate direct violence on the South Side?” she asked. This is the first time a medical-legal partnership has been used in a trauma center as a trauma prevention measure, she added.
The use of medical-legal partnerships to address the adverse social conditions that underlie health inequities is a relatively new approach, and has focused mostly on pediatrics. Studies show that these programs are often associated with increased access to care, fewer hospitalizations, and improved physical and mental health outcomes, especially among underserved communities. One study showed that patients whose housing needs were met had fewer hospitalizations and emergency department visits.
Public health is all about looking at risk and protective factors, said Kyle Fisher, policy director at the Violence Intervention Health Alliance and an emergency physician. Studies show that being shot immediately increases a person’s risk of being shot again. Programs like Recovery Legal Care work to reduce risk factors and improve protective factors, such as access to needed social services.
“It really helps fill an important need that has been neglected for too long,” Fisher said.
As with any new initiative, there are hurdles to overcome. Funding is a constant problem, Fisher said, adding that these types of programs are still fairly new. Education is needed about treating gun violence as a public health issue, as well as an emphasis on the value of prevention and solutions-oriented work for these programs.
“Part of it is about building a new standard of care for patients with violent injuries because the old standard of care is not enough,” Fisher said. “By building these programs, we’re helping to raise the bar for services that patients receive.”
Tong said the University of Chicago Medicine Trauma Center has been contacted by other hospitals to learn about their work in an attempt to replicate it. “It’s exciting,” she said. “There’s a lot of potential in adopting these types of practices in trauma.”
