$4.92 million NIH grant to support study of legal aid benefits for survivors of violence

A University of Chicago Medicine program designed to help survivors of violent crime has received a $4.92 million grant from the National Institutes of Health (NIH) to study whether providing free civil legal aid to patients improves their recovery and reduces their future likelihood of being involved in violence. 

The grant, distributed over three years, will support UChicago Medicine’s Recovery Legal Care initiative. It is the first program in the country to provide bedside civil legal aid services within a hospital-based violence recovery program to patients suffering from violent traumatic injuries.

The need is great: Only 16% of patients being treated for gunshot wounds at UChicago Medicine’s Level 1 trauma center receive their legal entitlements — such as public benefits — prior to injury.

That support can help patients focus on recovering, said Franklin Cosey-Gay, PhD, MPH, director of UChicago Medicine’s Violence Recovery Program, which offers trauma-informed care, case management and violence prevention services to people affected by violence.

"Taking this scientific, data-informed approach will help us justify beyond anecdotal stories why we need continued funding and why and how this could be the standard of care for the future of hospital-based violence intervention programs," said Cosey-Gay, who also serves as Recovery Legal Care's director of community engagement.

Since its launch in 2022, Recovery Legal Care has helped more than 400 patients secure public benefits such as crime victim compensation and Temporary Assistance for Needy Families (TANF), along with services that include criminal record expungement.

Supporting mental and physical health

The clinical trial will evaluate the impact that legal services offered by Recovery Legal Care have on patients’ health, safety and finance-related outcomes. Researchers will conduct an individually randomized group treatment trial to quantify the extent to which the program helps reduce patients' economic and social needs and improves their health and well-being.

"It's possible this can translate into reductions in violence involvement and improvements in both psychological and physical health," said Elizabeth Tung, MD, MS, a health disparities researcher and Recovery Legal Care co-director.

Tung and her colleagues aim to recruit 500 patients for the clinical trial. Participants will complete questionnaires over 24 months asking them about issues like post-traumatic stress, alcohol and illicit drug use, as well as their outlook on life.

"I have a strong sense that these resources will show better outcomes for our patients and increased morale for our team," Franklin said.

Recovery Legal Care's 2022 pilot program was funded with a $1.6 million NIH grant and a $1 million grant from the Department of Justice. The pilot focused on successfully embedding attorneys in the Hyde Park hospital in tandem with UChicago Medicine's Violence Recovery Program and trauma teams.

As part of the program, Legal Aid Chicago provides a supervising attorney, two staff attorneys and a paralegal to assist six new patients per week.

"This is a paradigm shift in how we view hospital-based violence intervention programs," said UChicago Medicine trauma surgeon Tanya Zakrison, MD, MPH, who is also a Recovery Legal Care co-director. "We believe we can evolve the model of trauma care to consist of medical-legal partnerships everywhere across the country."

Greater access to public benefits

More than 90% of UChicago's violent injury patients have legal needs related to income, Zakrison said.

One critically important benefit that often goes untapped is money available under the Illinois Crime Victims Compensation Act. It offers reimbursements of up to $45,000 for uncovered expenses such as lost earnings, mental health counseling and housing relocation.

There are many reasons why public benefits go unused by those who need them most, according to the researchers. Although some patients may not be aware of specific benefits programs, the overall application process for public benefits is incredibly complex, cumbersome and opaque. Missing a mailed document because a patient moved since registering for the benefit can be enough to lose the benefit.

"A lot of it has to do with the fact the system is just so insanely difficult to navigate, but it's also a system that is exclusionary by its construction, especially for communities of color due to historic and structural racism," Zakrison said.

"The system is built to essentially deny people benefits and exclude people from the public benefits economy, so a lot of times you actually need a lawyer to advocate for somebody to get those benefits."

The team is hoping to eventually conduct a multi-site clinical trial with similar programs in Atlanta, Georgia and Washington, D.C.