Recovery Legal Care Trial

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.

• Recovery Legal Care (Other): These patients will receive support from our HVIP standard of care (Violence Recovery Program) plus our Medical Legal Partnership (Recovery Legal Care) for additional legal support to address health-harming legal needs and public benefits.
• HVIP Standard of Care (Other): These patients will receive HVIP standard of care (Violence Recovery Program Support).

Primary outcomes

• Perceived Stress [Baseline, 3 months, 6 months, 12 months]: The Perceived Stress Scale-10 (PSS-10) is a 10-item psychological questionnaire used to measure how unpredictable, uncontrollable, and overloaded a person feels over the last month. Scores range from 0 to 40, with higher numbers meaning higher stress.

Secondary outcomes

• Firearm victimization and aggression [Baseline, 3 months, 6 months, 12 months]: The adapted Conflict Tactics Scale 2 (CTS2) measures behaviors related to firearm victimization and aggression. The adapted version includes 3 items on non-partner victimization and 3 items on non-partner aggression, each rated on a 7-point frequency scale (never to 20+ times). Each domain generates a score from 0 to 18 with a higher score indicating higher victimization or aggression.
• Legal needs self-efficacy [Baseline, 3 months, 6 months, 12 months]: Adapted Bandura Self-Efficacy Scale measures belief in one's ability to have legal needs addressed and is scored on a scale from 0 to 100, with a higher score indicating higher self-efficacy.

Other outcomes

• Health-related quality of life [Baseline, 3 months, 6 months, 12 months]: The SF-12 (12-Item Short-Form Health Survey) is a brief, 12-question patient-reported tool used to measure physical and mental health-related quality of life. Derived from the longer SF-36 survey, it takes about two minutes to complete and evaluates eight core health domains. The SF-12 survey yields two primary summary scores-the Physical Component Summary (PCS-12) and the Mental Component Summary (MCS-12). Both scores use norm-based calculations scaled to a general population average (mean) of 50 and a standard deviation of 10, with higher scores indicating higher quality of life.
• Post-Traumatic Stress Disorder (PTSD) Symptoms [Baseline, 3 months, 6 months, 12 months]: The PCL-5 (Posttraumatic Stress Disorder Checklist for DSM-5) is a 20-question self-test that tracks post-traumatic stress disorder (PTSD) symptoms. You rate each question from 0 to 4. Add all numbers for a total score between 0 and 80, with higher scores indicating more severe PTSD symptoms.

Sex: All, ages: 14 Years to any

Inclusion Criteria:

* Treatment for an interpersonal violent injury at the University of Chicago Trauma Center (e.g., gunshot, stab wound, assault)
* Ages 14+ years
* Able to provide informed consent (18 years and older) or assent (14-17 years)

Exclusion Criteria:

* Unable to provide informed consent due to mental status or severe mental illness
* Prior receipt of legal services at UCMC within the past year
* Currently imprisoned or incarcerated
* Residing at a non-Illinois address
* Non-English speakers

• Results publication: Tung EL, Pillai R, Sen-Gupta N, Nigro A, Cosey-Gay F, Stolbach BC, Rogers SO, Zakrison TL. Income Support Needs and Bedside Legal Assistance for Patients Recovering From Violent Injuries. JAMA Netw Open. 2025 Oct 1;8(10):e2538044. doi: 10.1001/jamanetworkopen.2025.38044. PMID 41100080

NIH grants: 5UH3HD111325-03