Income support needs and bedside legal assistance for patients recovering from violent injuries

Importance: Economic exclusion is a structural disadvantage that is challenging to address in violence reduction and recovery programs. Medical-legal partnership (MLP) is an effective practice for addressing poverty and increasing access to income support and other public benefits programs.

Objective: To examine the legal needs and access to public benefits among patients enrolled in Recovery Legal Care, a bedside MLP that supports patients recovering from violent injuries.

Design, setting, and participants: This cohort study involved patients recovering from violent injuries at an academic level 1 trauma center in Chicago, Illinois, who were enrolled in the Recovery Legal Care program and underwent legal needs screening and assessment from November 16, 2022, to November 11, 2024, with follow-up of financial benefits through June 30, 2025.

Main outcomes and measures: The main outcome were the number and types of legal needs reported by patients, as well as the financial benefit received. Legal needs were screened using the I-HELP (Income, Housing & Utilities, Education & Employment, Legal Status, and Personal & Family Stability) tool, followed by an 18-item assessment of specific public benefits needs; financial benefit was measured as a total lump sum financial benefit and annualized financial benefit.

Results: A total of 516 participants (median [IQR] age, 32 [24-40] years) were screened for legal needs; 437 (84.7%) were men; 439 (85.1%) self-identified as Black, non-Hispanic; 56 (10.9%) as Hispanic, Latino, Latina, or Latinx; 12 (2.3%) as White, non-Hispanic; and 3 (0.6%) as other race and ethnicity (American Indian and Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander). Among participants screened, 489 (94.8%) had at least 1 legal need, with income (461 [89.3%]), housing (332 [64.3%]), and employment (307 [59.5%]) being the most frequent needs. Most participants (406 [88.1%]) reported needing assistance with at least 1 of the listed benefit types, with 115 (25.0%) reporting barriers to accessing benefits in the past (eg, denial). Need for assistance was associated with living in the highest quartile of neighborhood disadvantage (adjusted odds ratio, 5.68; 95% CI, 1.05-30.71) relative to the lowest. During the study period, 694 legal cases were opened among 457 participants referred for legal intake. Common cases involved needs related to public benefits, criminal records expungement, employment, and housing. Of the 409 (58.9%) cases closed, 134 (32.8%) involved direct legal representation with financial benefit, yielding a total lump sum financial benefit of $264 068.10 and annualized financial benefit of $482 997.60 in recurring payments to patients.

Conclusions and relevance: In this cohort study, patients recovering from violent injuries had nearly universal legal needs, particularly for income support with public benefits. Legal assistance may be a pragmatic solution, infrequently leveraged in addressing violence, that can increase access to income support and other public benefits programs.