Integration of Medical Legal Services into a Hospital-Based Violence Intervention Program: A Survey and Interview-Based Provider Needs Assessment

Jake Sonnenberg; Ariana Metchick; Caitlin Schille; Prashati Bhatnagar; Lisa Kessler; Deborah Perry; Vicki Girard; Belinda Taylor; Erin Hall

doi:10.1097/TA.0000000000004302

Integration of Medical Legal Services into a Hospital-Based Violence Intervention Program: A Survey and Interview-Based Provider Needs Assessment

J Trauma Acute Care Surg. 2024 Mar 14. doi: 10.1097/TA.0000000000004302. Online ahead of print.

Authors

Jake Sonnenberg¹, Ariana Metchick², Caitlin Schille³, Prashati Bhatnagar³, Lisa Kessler³, Deborah Perry³, Vicki Girard³, Belinda Taylor³, Erin Hall

Affiliations

¹ University of California, San Francisco, School of Medicine, 513 Parnassus Avenue, San Francisco, CA.
² Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road, NW, Washington, DC.
³ Georgetown University Health Justice Alliance, Georgetown University School of Law, 600 New Jersey Avenue NW, Washington, DC.

PMID: 38480487
DOI: 10.1097/TA.0000000000004302

Abstract

Background: Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently-injured patients.

Study design: An electronic survey tool was distributed to clinicians and staff affiliated with the hospital-based violence intervention program at a single urban level one trauma center. Semi-structured follow up interviews were conducted with participants, and interviews were coded using thematic analysis and grounded theory.

Results: Participants reported many health-harming legal needs among their violently injured patients. The most commonly-identified needs were: health insurance denials (62.5%); difficulty accessing crime victims compensation funds (56.3%); trouble accessing official documents (50%); and problems with non-SSDI public benefits (50%). Participants reported inconsistent methods for learning about and responding to patients' health-harming legal needs. The most common barriers to addressing these needs included: lack of awareness that a lawyer could help with the issue (68.8%); prioritization of other needs (68.8%); previous negative legal experiences (62.5%); and cost (62.5%). Identified needs encompass issues traditionally-addressed by MLPs as well as more novel challenges faced by violent injury survivors.

Conclusion: This survey and interview-based study identifies complex health-harming legal needs present among violently-injured trauma surgery patients. Medical-legal partnerships specially-designed for the setting of violent injury appear well-suited to meet these needs, potentially reducing risk of violent re-injury, long-term negative health outcomes, and healthcare system costs.

Level of evidence: Level IV / Prognostic and Epidemiological.