Those of you who live in Greater Boston (and in other crowded urban areas across the globe) know just how hard finding affordable housing can be under the best of circumstances. Losing one’s housing on short notice makes the situation much, much harder….
Triage and Justice for All
When legal resources are scarce, attorneys must prioritize who receives which services.
Right now, in the United States, some victims of domestic and intimate partner violence (DV/IPV) do not obtain restraining orders against their abusers, not because their facts fail to meet applicable legal standards, but rather because legal services providers lack knowledge needed to allocate scarce resources well, i.e., to triage. Were such triage know-how available, more DV/IPV victims might obtain restraining orders, even without new resources.
What is triage?
Triage is scarcity-compelled choice. The military setting provides a useful guide. The Navy Hospital Corpsman Manual instructs field medical technicians facing emergencies with multiple civilians to divide human beings into three classes:
- Priority I. Victims who “require immediate life sustaining action.”
- Priority II. Victims with “injuries where treatment can be delayed for a short time.”
- Priority III. Those who either “have minor injuries,” or those with “obviously mortal wounds where survival is not expected.”
When resources are too scarce to permit treatment to be given to all, the Manual’s instructions are clear: treat Priority I patients. When you cannot treat everyone, treat those who will live with treatment but die without it. Doing anything else may cost lives. Most critically, the Manual provides instruction on how to identify and separate these classes.
On a day-to-day basis, legal aid attorneys facing severe resource constraints should provide representation first to Priority I victims. Doing anything else may cost lives.
At current resource levels, every representation given to a victim in Priorities II or III (i.e., those for whom representation can make no difference vis-à-vis restraining orders) means that two other victims, perhaps two other Priority I victims, go unrepresented. Like Navy Corpsmen, legal aid attorneys may despise the necessity for triage, but they cannot escape it. Some triage mechanism is unavoidable.
But unlike Navy Corpsmen, legal aid attorneys have no manual to instruct them on how to identify those who will obtain restraining orders (no matter what) and those who will not obtain restraining orders (no matter what) from those who will obtain restraining orders only if legal aid attorneys represent them.
Why is there no such manual? Because no one knows what the manual would say. No one has ever researched how to triage well in the DV/IPV context, nor in any legal context, even though courts and attorneys make triage decisions daily.
The Intimate Partner Violence Triage Study will provide the first rigorous study of triage in the DV/IPV context. It will do so using a randomized control trial design in partnership with a legal aid organization in northeastern Ohio.
A key element to this project involves creating self-help materials that are useful and accessible, and that convey the appropriate message to the audience. We have developed several sets of images to accompany the text for these materials.
Please help us by casting a vote for the image you think works best.
After a thorough screening and intake process, a legal aid attorney will make a provisional triage decision assigning each eligible and consenting DV/IPV victim to one of its three service levels: (a) full attorney representation; (b) an instructional telephone call plus a self-help assistance packet; or (c) a self-help packet alone.
Eligible and consenting individuals are then randomized into one of two groups:
- Triage by an attorney: the person will receive the service that is decided by the attorney.
- Randomized triage: the decision made by the attorney will be ignored, and the person will be provided a randomized level of service as chosen by a computer.
The Research Team will follow each victim to discern whether she obtains a restraining order, and subsequently, whether she seeks refuge at a shelter (a strong indicator of revictimization). Depending on funding and the availability of records, the Research Team will also examine police records (to see whether a subsequent encounter is reported for the victim and her abuser) as well as Medicaid expenditures for each victim. By comparing these outcomes across the two treatment arms, the Intimate Partner Violence Triage Study will assess the effectiveness of the attorney-led triage process in DV/IPV cases.
Unlike many randomized trials, however, the Study will go beyond mere “treated” versus “control” comparisons and provide strong guidance to future service providers and researchers. Specifically, the presence of a fully randomized group (the second treatment arm) will allow the researchers to provide data-driven, rigorous evidence on the following questions critical to the legal scheme constructed to protect DV/IPV victims:
- What background variables (observable at intake) predict whether a legal aid provider will offer higher as opposed to lower levels of service?
- What background variables (observable at intake) predict whether a DV/IPV victim can obtain a restraining order on her own?
- How much does legal representation increase the probability of obtaining a restraining order over a telephone call and/or a self-help assistance packet?
- How effective is a restraining order in preventing revictimization, forestalling the need for subsequent police calls, and reducing state medical expenditures?
The Research Team
Marie Curry, Managing Attorney, Health, Education, Advocacy & Law Program, Community Legal Aid Services, Inc.
Jim Greiner, Faculty Director, The Access to Justice Lab; Professor of Law at Harvard Law School
Erika Rickard, Associate Director of Field Research, The Access to Justice Lab
David Yokum, U.S. Social & Behavioral Sciences Team