Recovery Legal Care Randomized Trial

Overview

Hospital-Based Violence Intervention Programs (HVIPs) affiliated with U.S. trauma centers often focus on individual behavior modification to reduce re-victimization. There is a lack of reproducible evidence that has demonstrated effectiveness, given the exclusion of addressing social and economic risks, often the root cause of violent injury and preventable homicide. This study tests a novel Medical-Legal Partnership that offers legal support to address social and economic risks, reduce perceived stress, and reduce firearm injury, while collaborating with the CFVP Coordinating Center for broad trauma center distribution and public health impact.

National trauma center verification relies on a commitment to injury prevention efforts, including prevention of community-level violence. Hospital-Based Violence Recovery Programs (HVIPs) have expanded across the country as extensions of Level I and II trauma centers to address trauma recidivism with individual behavioral modification during the "teachable moment". There is no evidence to date that has demonstrated effectiveness in this approach for HVIPs, despite proliferation across the country. A criticism of this approach to violence prevention is the difficulty for community-based violence prevention specialists from HVIP programs to address the broader social and economic risk factors that lead to violence through individual behavior modification. Medical-Legal Partnerships (MLPs) have been one approach that has demonstrated evidence and success in improving health outcomes and reducing health-harming legal needs of patients by connecting legal experts to medical experts for holistic care. The MLP approach has yet to be done for trauma patients and has not been incorporated into any HVIP approach thus far. In the study's biphasic proposal, the UG3 aims are to clearly identify the types of health-harming legal needs of patients and families affected by firearm violence and examine the population-level differences in types of legal needs by sociodemographic and geographic factors. The investigators then aim to develop the HVIP-MLP model for implementation at an urban, Level I Trauma Center on the South Side of Chicago. The UH3 aims are to examine implementation outcomes (acceptability and feasibility) of this novel MLP compared to standard of care with HVIP; and examine health outcomes via a clinical trial measuring primary health outcome (perceived stress) and secondary outcomes (improvements in legal need self-efficacy, PTSD symptoms, and firearm aggression and victimization). Close coordination with the CFVP Coordinating Center will be essential for data handling, measurement, analytics support and consultation with future public/stakeholder engagement and dissemination to demonstrate public health impact. This novel HVIP-MLP approach has the potential to broadly impact the HVIP model to include an MLP component to all trauma centers for verification to support patients, families and providers alike in this important public health work.