Toward the end of spring last year, Gina got a call that her daughter Bianca was admitted to the University of Chicago Medicine’s trauma center. A person close to Bianca had put her in harm’s way and she was shot 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 on survivor services and financial assistance programs. The coordinator also screened them for a newly created partnership between the hospital and Legal Aid Chicago, a nonprofit organization 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, like acquiring public benefits. The goal is to break down the barriers families face after a violent injury and provide them with access to benefits and resources that can help their long-term health outcomes. Navigating the bureaucratic process and paperwork to obtain those resources is complicated, and sometimes legal assistance is needed to access them and appeal any denials.
“Legal services are expensive,” Gina said. “If you’re a struggling family, a low-income family, and you don’t have the money to do the legal work, then you’re just left out.” (The Trace agreed to refer to Gina and Bianca by pseudonyms to allow them to speak openly without fear of retribution.)
Bianca survived, but was physically impaired and is unable to work. She applied for disability benefits, but more than one year on, approval is still pending. On top of her own needs, Bianca’s child is also physically and developmentally impaired. To help, the medical-legal partnership obtained disability benefits for her child, resolved a health insurance issue that blocked access to prescription medication, helped Bianca receive Temporary Assistance for Needy Families (TANF) benefits, and submitted paperwork to safeguard her physical well-being.
The partnership’s coordinators are still analyzing a year’s worth of collected data, but so far, the program has been successful in helping the majority of participants access benefits they either didn’t know about, or didn’t previously receive. In addition to closing a legal advocacy gap, the program has presented a new standard of care for patients who have been injured by gun violence.
Gina said that receiving help while her family processed her daughter’s injuries provided relief. Without the program, her family wouldn’t have known about some of the benefits they are now getting. “It’s very helpful because they will see and say things that you’re not thinking about, because you’re dealing with a stressful situation,” Gina said. “It comes in handy to have somebody with a level head behind you.”
Program breaks barriers to legal, social, and economic needs
The idea for Recovery Legal Care first came to be in early 2021, three years after the University of Chicago Medicine launched its Level 1 adult trauma center and its Violence Recovery Program. Trauma surgeon Dr. Tanya Zakrison and Dr. Elizabeth Tung, an internal medicine physician, received feedback from their patients that, beyond medical needs, they also faced social and economic concerns. The physicians realized that if they didn’t address these needs, their patients would likely return to the hospital with new firearm injuries.
But referrals to resources were not enough, and Zakrison and Tung, principal investigators of the program, created a medical-legal partnership with Legal Aid Chicago to ensure that patients would receive the legal help they need. After receiving initial funding from the Office of Juvenile Justice and Delinquency Prevention and subsequent funding from the National Institute of Health, program coordinators began screening patients for “health-harming legal needs” in November 2022. These include any issues that negatively impact a person’s health and quality of life, including their 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 over 97 percent had at least one health-harming legal need. Almost 87 percent had more than one. A majority of those needs were related to public benefits that patients were not receiving.
“It’s been really rewarding to see that patients are getting what they deserve, especially after going through something really traumatic,” said Rhea Pillai, project coordinator for the program. In her role, Pillai makes initial contact with the patients at their bedside, conducts the legal needs assessment, and evaluates data.
To enter the program, patients have to be admitted to the University of Chicago Medicine’s trauma center for a violent injury, like a firearm injury, and be at least 14 years old. Citizenship status and criminal history does not factor into whether a person is eligible. On the contrary, a legal referral can also be made to help with immigration issues and record expungements.
Trauma centers, Tung said, serve patients who usually don’t interact with the healthcare system and who are most in need of economic and legal support. Among program participants, about 84 percent were men and 85 percent were Black.
“There are all of these structural barriers that are legacies of racism over the years, and the barriers result in people needing a lot of resources that were really not created for them but are needed,” Tung said. “They are entitlements that they should receive.”
Beyond navigating complicated applications and facing language barriers to receive help, Black and brown communities have historically been denied benefits or have disproportionately received sanctions for not following a program’s requirements. The inequitable access exacerbates health disparities. Studies have shown that safety-net programs that increase incomes for families are associated with improved health.
Pillai said the goal is to provide holistic care to not only the injured person, but to the entire family. She shared the story of one person who was paralyzed from a firearm injury and through the program received home health services, including wheelchair accessibility. On top of that, the legal team appealed the revocation of food assistance benefits for the patient’s mother, and were able to secure those benefits again with an additional monthly increase of over $500.
Tackling gun violence with public health solutions
As a trauma surgeon, Zakrison sees first-hand the impact that gun violence has in the community surrounding the University of Chicago’s hospital and said the majority of firearm violence is rooted in racial and economic disparities. “If we eliminate the structural violence, will that eliminate the direct violence on the South Side?” she asked. This is the first time, she added, that a medical-legal partnership is being used in a trauma center as an injury prevention measure.
Using medical-legal partnerships to address adverse social conditions underlying health inequities is a fairly new approach and has mostly been centered on pediatrics. Studies show that these programs are often associated with greater access to care, fewer hospitalizations, and improved physical and mental health outcomes, especially among disadvantaged communities. One study showed that patients whose housing needs were met had fewer inpatient admissions and emergency department visits.
Public health is about looking at risk and protective factors, said Kyle Fischer, policy director at the Health Alliance for Violence Intervention and an emergency physician. Studies show that being shot immediately puts a person at higher risk of being injured again. Programs like Recovery Legal Care decrease risk factors and improve protective ones, like receiving needed social services.
“It’s really helping fulfill an important need that has been neglected for much too long,” Fischer said.
As with any new initiative, there are obstacles to overcome. Funding is always an issue, Fischer said, adding that these types of programs are still fairly new. Education about approaching gun violence as a public health issue is needed, as well as a focus on the value of the preventative, solutions-oriented work of these programs.
“Part of it is about building a new standard of care for violently injured patients because the old standard of care is insufficient,” Fischer said. “By building these programs, we are helping elevate the services that patients get.”
Tung said the University of Chicago Medicine’s trauma center has received outreach from other hospitals to learn about their work in an attempt to replicate it. “It’s exciting,” she said. “Adoption of these types of practices in the trauma space has so much potential.”