Abstract
Risk-based firearm laws are a firearm injury prevention strategy. However, evidence for their efficacy in reducing firearm injury is mixed. There is agreement that the magnitude of their effect depends on implementation and efficacy would improve with better implementation. Local context and processes are key to evaluating outcomes of these laws. To contribute to the evidence base we conducted a case study of Firearm Restraining Order (FRO) implementation in Lake County, Illinois. The details of Illinois FRO policy are, similar those of other locations with notable exceptions that in Illinois roommates are allowed to petition and medical care providers are not. The study examined data from court documents related to 42 FRO petitions filed between January 2021 and June 2024. Lake County is similar to other locations studied in terms of respondent demographics including age, race and gender. It differs in the distribution of types of incidents precipitating FROs. Lake County has a greater share of emergency FROs petitioned due to threats related to harm to others, while other locations studied typically have a higher burden of self-harm threat incidents triggering FRO initiation. The share of initiating incidents related to mass shooting threats is similar to that of other locations studied. In Lake County, IL most petitioners are law enforcement officers with few petitions made by others enabled by the law. This too is similar to that of other jurisdictions. Our study finds that in Lake County the EFRO petition process generally proceeds within established policy timelines and the majority of FRO cases resulted the issuance of plenary FROs. Two implementation areas identified for further investigation include the low level of intimate partner notification when an emergency FRO is petitioned and the volume of emergency FRO dismissals due to lack of petitioner appearance at plenary FRO hearings.
Keywords: firearm injury prevention, firearm policy, firearm restraining order, suicide prevention, policy implementation
Highlights.
● Firearm restraining orders (FRO) are a civil action to temporarily remove firearms and prohibit purchase of firearms by people deemed to be at risk of injuring themselves or others with a firearm.
● FRO efficacy in reducing firearm injury is mixed and dependent on local context and implementation, thus local implementation studies are needed to evaluate FRO efficicacy.
● FRO implementation in Lake County, IL generally follows established policy timelines but the number of FRO petitions is less than would be expected for a county of its size.
● In Lake County, IL most FRO petitions filed result in FRO issuance, are issued for threats to others and, are petitioned for by law enforcement.
● Primary reasons for petitions dismissals include proceedural issues (wrong jurisdiction, wrong mechanism), alternative arrangmenets to remove weapons, and failure of petitioner to attend the plenary hearing. Failure to attend the plenary hearing was the largest reason for FRO petition dismissal.
● Combined with other local implementation studies, these findings help to inform implemenation improvements and interpret FRO outcomes.
Background
Risk-based firearm laws create a civil process to temporarily prohibit possession and purchase of firearms by persons deemed at risk for harming themselves and others. Currently, 21 states, the District of Columbia and the Virgin Islands have enacted a variant of risk-based firearm laws. 1 While these laws share a basic framework, they differ from state to state in terms of criteria required to issue an order, who may petition the court for an order, and availability of pre-hearing emergency orders. In Illinois, this type of risk-based firearm law is known as Firearm Restraining Orders (FRO).
The Consortium for Risk-Based Firearm Policy recommends states adopt FROs as part of a gun violence prevention strategy.2 -15 A number of studies have found that FROs may contribute to declines in suicide, with less evidence for homicide reduction.2,11,16 However, a review by the RAND Corp found inconclusive evidence for FRO efficacy. 17 Despite the lack of consensus on the efficacy of FROs, there is growing agreement that the magnitude of FROs’ effect likely varies depending on how FRO laws are implemented, and efficacy would likely improve with better implementation.17 -19 Furthermore, there remain concerns regarding disparities in the implementation and outcomes of FROs across racial and ethnic groups. 20 Knowledge about implementation barriers, facilitators, and processes is crucial to accurately assess FRO efficacy in reducing firearm injuries. Calls for implementation research have clarified that knowledge of local context and processes is integral to evaluating outcomes. Because implementation can differ due to local factors, local analyses are needed to examine implementation to inform policy. 18
Overview of Illinois Firearm Restraining Order Act
The Act (430 ILCS 67/1 21 ) took effect January 1, 2019 and is part of a comprehensive set of gun regulations in Illinois. The Act provides a civil legal process adjudicated through the circuit court system for the prohibition of purchase, and procession of firearms and removal of Firearm Owners Identification (FOID) card for persons deemed at risk of causing harm to themselves or others. Two types of FROs are enabled. An emergency FRO (EFRO) is issued after a petition is filed and an emergency hearing which the respondent (firearm owner) does not have to attend is held. The EFRO is in effect for 14 days or until a full plenary FRO (PFRO) hearing can be held. After an EFRO is issued, a warrant is served to allow removal of FOID cards, firearms, ammunition, and firearm parts. Inventory documents detailing firearms, ammunition and firearm parts seized are completed.
The PFRO hearing requires that both the petitioner and respondent attend. If at the hearing it is found that the respondent meets the risk criteria, the PFRO is issued. The PFRO is in effect for 1 year or until a dismissal or extension is issued. In 2023, the Protect Illinois Communities Act extended the PFRO term from 6 months to 1 year. 22 Eligible petitioners include spouses and former spouses, persons with whom the respondent has a minor child in common, parents, children and step children, any other person related by blood or current or former marriage, persons who share a common dwelling, and law enforcement officials. Health care providers, educators, mental health professionals and workplace colleagues are not allowed to petition for a FRO in Illinois. In comparison, seven of the 21 states with FRO laws allow for health care provider petitions, 2 allow for coworker petitions and 4 allow for educators and school personnel to petition. FRO petitions may only be made in the county where the respondent lives or where qualifying incidents took place. Respondents have the option to file 1 early termination application should the PFRO be issued. The PFRO can be extended for 1 additional year.
To date, Illinois has implemented FROs infrequently compared to other states.11,23 -25 Moreover, the use of FROs in Illinois is not uniform, with only one-quarter (25.4%) of counties having issued at least 1 FRO in 2023. In 2023, based on data from the Illinois State Police’s Annual Report for the Commission on Implementing the FIrearms Restraining Act, 16 EFROs were issued in Lake County (5 of which converted to PFROs), representing 19.8% of all FROs issued in Illinois. 25 For comparison, DuPage County, the second most populous county in Illinois with 924 885 residents, had a total of 30 EFROs (22 of which converted to PFROs) representing 35.1% of all FROs issued in Illinois in 2023.25,26 The limited and uneven implementation of FROs in Illinois suggests underlying implementation issues.
In this case study of FRO implementation in Lake County Illinois we examine all emergency FRO petitions and subsequent FRO-related court documents filed through the Lake County Circuit Court system between January 2021 and July 2024 to assess implement processes. Our objective is to identify petitioner and respondent characteristics, and implementation timelines, and outcomes. This, along with findings from other localities can help to build the evidence base on FRO, inform implementation improvements and more accurately evaluate FRO efficacy in reducing firearm injuries.
The Implementation Process in Lake County, Illinois
See Figure one for a detailed flow chart of the FRO emergency and plenary court processes. The process begins with a petitioner submitting an emergency FRO (EFRO) petition to the Lake County Circuit Court system. This results in an EFRO hearing being held the same or next day after the petition is filed. The EFRO hearing has 2 possible outcomes—(1) a finding of proof that the respondent is a threat to themselves and/or others via firearms or (2) dismissal based on a procedural issue or a judge’s finding of insufficient evidence of threat. At this point, dismissed petitions may be resubmitted, beginning the petition process again.
If there is a finding of proof of threat, an EFRO is issued, and a hearing date is set within 2 weeks of the EFRO issuance. In some, but not all cases, a search warrant and summons to the plenary hearing are issued to the respondent by law enforcement at the time the plenary hearing date is set. If a seizure is executed an inventory form is filed tracking seized firearm, ammunition and FOID cards.
The next step is the plenary hearing typically held within 2 weeks of the EFRO hearing. Prior to the plenary hearing the respondent has 1 opportunity to file for a dismissal to be heard at the plenary hearing. At the plenary hearing, the FRO case can be dismissed due to any 1 or more of the following: petitioner fails to appear, petitioner withdraws petition, the respondent’s application for dismissal is granted, there is a finding of insufficient evidence of threat to self or others via firearms, or there is a jurisdiction or procedure issue that invalidates the petition.
At the plenary hearing, If the judge finds sufficient evidence of threat to self and/or others via firearms, a plenary FRO (PFRO) is issued for up to a 1-year period and a hearing set for the day of the PFRO expiration to determine continuance or dismissal. If a PFRO petition is granted, a law enforcement officer will process an affidavit for the hearing outcome and typically serve it to the respondent immediately following the plenary hearing.
At the 1-year PFRO expiration hearing, a second petition may be filed to extend the current PFRO or the FRO petition may be dismissed due to a finding of lack of continued threat to self and/or others via firearm. A new petition can be filed upon PFRO dismissal, beginning the entire process again.
Methods
This study received human subject research approval from the Northwestern University Institutional Review Board, study number STU00213887.
Study Setting
Lake County, Illinois is the third most populous county in Illinois with 714 342 residents. 26 The population of Lake County is racially, ethnically and economically diverse and the geography ranges from large cities to rural areas. Lake County provides an ideal setting in which to study FRO implementation given that there is some level of issuance, but issuance is below what would be expected in a county of this size.
Data Sources
Data come from FRO petitions and related court documents filed in the Lake County, Illinois Circuit Court system between January 1, 2021, and June 30, 2024. Data were accessed through the eFileIL system, the mandatory on-line system for filling civil cases in Illinois Circuit Courts. Data abstraction was done on site at the Lake County Courthouse which serves as the main branch for the Circuit Court in Lake County. In Illinois, there are 7 FRO related forms, all linked by a case identification number. Each FRO case is assigned a case number at initial filing (Emergency Firearms Restraining Order petition). Data were abstracted in August 2024. FRO documents dated before 2021were sealed and unavailable for review. In all, we entered data for 453 variables from the 7 FRO forms. Variables included in the analysis are: responder age, race/ethnicity, gender, petitioner relationship to respondent, incident description (unstructured text), petition date, EFRO issuance, date of affidavit testifying to summons service, suspected weapons and ammunition (unstructured data from petition), weapons and ammunition seizure record (unstructured text), PFRO hearing date, PFRO hearing outcome, reason for case dismissal, and PFRO issue date. Cases filed prior to 2021 are sealed and inaccessible. Not all cases had all forms available via eFileIL.
Methods
In addition to the 453 variables entered from the FRO forms, we created several variables for analysis by calculating the number of days elapsed between different stages in the FRO processes and by coding the type of incident that formed the basis for FRO seeking. For example, we calculated days elapsed between EFRO petition and EFRO issuance.
We coded incident types by noting whether the threat is described as to self (suicide), others (family members, partners police, neighbors, the public) or involving threat to both self and others. We characterized incidents for mass shooting threat as incidents where the target of gun violence was described as a place, group of people or a location that was not specific to personal relationships. For example, a threat to “shoot up” a school versus to shoot a specific person and in which multiple victims were targeted. Incident descriptions were coded using categories commonly found in the FRO literature and rechecked for agreement after initial coding. We also noted when mental health conditions, drug and alcohol intoxication, and domestic violence were mentioned in incident descriptions.
We created a diagram of the FRO process (Figure 1) to conceptualize relationships among the steps involved beginning with EFRO petition initiation based on a review of the forms and the data.
Figure 1.
Implementation process.
We also cross-walked ERFO respondents to the Illinois Violent Death Reporting System (IVDRS) to identify violence-related deaths among respondents occurring from 2021 to 2022 (the latest years for which data were available).
We used descriptive statistical methods in IBM SPSS Statistics 29.0.0.0 to characterize FRO respondents, petitioners, incidents that triggered FRO filings, FRO processes, and FRO outcomes.
Results
Emergency Petitions Initiated
We identified a total of 43 petitions meeting our eligibility criteria based on a list provided by the Lake County State’s Attorney’s Office. The 43 petitions constitute a complete list of EFRO petitions (all FROs start with an EFRO petition) available through the online court record keeping system for Lake County from January 1, 2021, to June 30, 2024. Of these 43 cases, 1 duplicate case where a petition was begun and abandoned and another petition for the same respondent was started on the same day, was excluded from analysis.
Emergency FRO Petitions Issued
All 42 ERPO petitions filed resulted in a same day EFRO issuance.
Firearms Reported in Procession of Respondents
EFRO petitions ask petitioners to list the weapons suspected of being in the respondent’s possession. Among the 42 EFRO petitions, a total of approximately 109 firearms were listed as suspected to be in respondents’ possession at the time of petition filing. An approximate number of weapons is listed because some of the forms listed “several” or “multiple” weapons but did not list an exact number. We counted each of these instances as 2 weapons to derive a conservative estimate.
Precipitating Incidents
The number of precipitating incidents leading up to the petition filing listed in any 1 EFRO petition ranged from 1 to 14. Three quarters (30 of 42) cases had only 1 incident described.
The majority (26 of 42) of incident(s) precipitating EFRO petitions involved threat of harm to others, 7 of 42 were self-harm threats, 4 of 42 were threats combining self-harm and harm to others. A little more than a 10th (5 of 42) did not have an incident description or contain enough detail to accurately determine the nature of the threat.
Other features of incident descriptions we tracked included respondent with a known or suspected mental health issue noted in the incident description (13 of 42), incident was domestic violence related (12 of 42), involved stalking (2 of 42), mass shooting threat (eg, threats to “shoot up” a public space or community; 4 of 42) and alcohol/substance intoxication (2 of 42).
Respondent Characteristics
Of the 42 EFRO respondents, 2 were juveniles and another 2 were persons over 64 years of age. The age range of respondents was from 14 to 80 years. Respondents were mostly male, and White. See Table 1 for respondent demographics.
Table 1.
EFRO Respondent Demographics.
| Characteristic | n | % |
|---|---|---|
| Race/ethnicity | ||
| White | 76.2 | 32 |
| Black | 11.9 | 5 |
| Hispanic | 7.1 | 3 |
| Gender | ||
| Male | 98.2 | 41 |
| Female | 1.2 | 1 |
| Mean | Standard deviation | |
| Age in years | 41.6 | ±14.8 |
Geographies Represented
Respondents came from 21 different municipalities, but about one-third (16) came from just 3 of the 21 cities represented.
Petitioner Characteristics
Petitioners were mostly (38 of 42) law enforcement officers. Spouses, children, roommates, and parents make up the remaining 5 of the 42 petitioners.
Search/Seizure Warrants Issued
Once an EFRO has been issued, a judge may issue a search/seizure warrant for weapons as provided for in the EFRO. Documentation of execution of the search/seizure of weapons provided for in the EFRO was available for 16 of 42 of EFRO petitions issued. Of those with record of search and seizure execution 12 of 42 had search and seizure executed the same day as the EFRO issuance, 3 of 42 had search and seizures executed the day after EFRO issuance and 1 of 42 had a 12-day lapse between the EFRO issuance and search and seizure.
Notably, no search and seizures were documented for Black or Hispanic respondents while 14 of 32 white respondents had search and seizure forms on file.
Inventory of Seized Weapons
The inventory of seized firearms among those 16 cases with documented search and seizures included 32 firearms, at least 50 stores of ammunition, 1 laser sight, 3 silencers, 1 scope, 1 pellet rifle, and 1 handgun.
The majority (33 of 42) of EFRO petitions had record of a respondent being served with an affidavit notifying them that they are named as a respondent to an EFRO and summoned to appear in a PFRO hearing. The average number of days elapsed between EFRO issuance and affidavit service was 4.88 (range 0-21 days, SD + 6.4).
PFRO Hearings
As provided by law, EFROs are established for a 2-week period or until a hearing can take place to determine if there is cause to issue a PFRO. The average time between EFRO issuance and EFRO end date (PFRO hearing) was 14.95 days (SD + 3.76). The number of days ranged from a minimum of 7 to a maximum of 21. In several cases extensions were granted due to respondent request, difficulty in locating the respondent, or because the respondent was in custody or hospitalized during the 2-week hearing timeframe.
Among the 42 EFROs issued, 25 of 42 moved from EFRO to PFRO issuance at the plenary hearing. PFRO issuance appears to differ by race with most (25 of 32) White respondents issued a PFRO while only 2 of 5 Black respondents issued a PFRO. Hispanic respondents had PFRO issuance (2 of 3) similar to that of White respondents.
Among the 25 respondents with PFROs issued, only 2 were issued before 2023 when PFRO period increased from 6 months to 1 year.
Dismissals
About one-third (13 of 42) of EFRO cases were dismissed at the plenary hearing. Most (10/77%) dismissals were due to lack of appearance by petitioner at the PFRO hearing. Of those 10 cases dismissed due to lack of petitioner presence at hearing, 9 were cases with a law enforcement petitioner. Other reasons for dismissal include lack of court jurisdiction to issue a PFRO (1), weapon voluntarily transferred to a family member (1), lack of cause (1), previous removal of firearms (1), and cause not suited to a FRO (3). Note that there can be more than 1 reason for a dismissal.
No respondents had petitions for an early dismissal of the FRO on file.
Illinois allows for several additional actions to support the FRO process. One is to notify respondent intimate partners of intent to petition for an EFRO. A minority (7 of 42) of petitions endorsed this. Only 2 cases stated a reason for failure to notify intimate partners and both were due to lack of ability to reach the partner by telephone. Another additional action is that law enforcement petitioners are encouraged to provide referrals to appropriate support services at EFRO petition serving. Just over two-thirds of law enforcement petitioners attested to doing so.
Only 2 applications for PFRO extension were filed during the study period.
When linking FRO respondents to the IVDRS decedent data, we found only 1 of the 42 respondents went on to die from a violence-related injury between 2021 and 2022 (note as of this writing violent death data are only available for deaths up to December 31, 2022).
Limitations
As with many studies of risk-based firearm restriction policies, our study is hampered by the relatively low number of documented cases, incomplete documentation, and the relative recent enactment of the policy that can make it difficult to acquire data. The relatively few respondents identified as Black or Hispanic limited our ability to examine racial/ethnic differences in FRO implementation outcomes. Furthermore, we are limited by our ability to link the data to further downstream outcomes such as criminal justice involvement and re-issuance of FOID cards to better assess longer term outcomes.
Discussion
The literature on FROs is inconclusive regarding outcomes for preventing firearm injury and death.17,27 Some studies find a reduction in firearm injury and death, others do not.8,9,11,28,29 Many policy experts and researchers who study FRO laws point to its relatively recent use and expansion and the need to establish implementation efficacy prior to outcomes evaluation. 15 Common foci for implementation studies include racial equity, uptake and implementation mapping. 27 This study examines the implementation of FRO legislation in Lake County, Illinois as a contribution to this growing body of work.
Details of Illinois FRO policy are, for the most part, similar to those of other locations with the notable exception of who may petition for a FRO. In Illinois, unrelated persons who share a common dwelling are allowed to petition whereas in some other states they are not. However, in Illinois health care providers, mental health providers, educators, school personnel and co-workers are not allowed to petition but some states allow these categories of petitioners. Because most petitioners in our study were law enforcement officers, we do not find the distinction of who is able to petition a significant factor in FRO implementation in Illinois, but questions remain as to whether allowing expanded categories of petitioners would shift this finding.
Initially FRO legislation established a PFRO removal period of 6 months. This was extended to 1 year in 2023, bringing it into alignment with most other jurisdictional FRO policies. We have no information to indicate whether the extension of the PFRO removal period may have influenced FRO implementation but do note that this change coincides with an increase in the number of EFRO petitions.
While the number of EFRO petitions issued in Lake County is below what one would expect for a county of its population based on data from other locations,11,16,24 there is no straightforward way to objectively determine if the number of EFRO petitions adequately reflects the level of FRO appropriate threat present. However, we do note an increase in the number of EFRO petitions filed over time indicating increased implementation uptake and perhaps signaling movement toward closing a gap between need and use.
In Lake County, as elsewhere the EFRO petition via circuit court process moves through several stages and procedures and subsequent steps are dependent on outcomes from prior steps (see Figure 1). The FRO process has emergency and plenary phases with different procedures, timelines and processing requirements for issuance depending on the phase. The EFRO petition is designed to respond in a timely manner to imminent threat and authorizes short term removal of firearms and FOID cards suspension in a process that does not require respondent presence at the emergency hearing. The PFRO is designed for longer term, but still temporary removal of firearms and FOID cards. The PFRO provides more opportunities for the respondent to attend the hearing (extended notice, ability to reschedule based on availability) than available in the EFRO process. We note several instances when hearings were delayed because a respondent was hospitalized or in custody. It appears that as implemented in Lake County, the PFRO hearing process is accommodating the needs of respondents regarding their right to appear at a hearing.
Lake County is similar to other locations studied in terms of respondent demographics including age, race, and gender.5,11 Unfortunately the small sample size prohibits us from conducting more rigorous assessment of racial equity in FRO implementation but we do note that Black respondents uniformly had no record of firearm seizure and removal compared to respondents of other races. We also note that a lower proportion of EFRO cases resulted in PFROs for Black and Hispanic respondents compared to White respondents. These observed differences raise questions regarding race-based differences in FROs and underscore the need for equity based evaluations as found in the literature. 15 A more rigorous examination of these and other factors by race is needed with a larger sample as FRO implementation continues.
Lake County differs from other jurisdictions reported in the literature in that a greater share of EFROs are petitioned due to threats related to harm to others compared to other locations studied which generally have a higher burden of self-harm threat incidents triggering FRO initiation.11,30 Notably, the share of initiating incidents related to mass shooting threats appears similar to that of other locations studied. 23 That the greater proportion of FROs pertained to harm to others threats is somewhat surprising given that the 2023 suicide rate in Lake County, Illinois was 4 times greater than the homicide rate (12.7 vs 4.0 per 100 000). 31
In Lake County, IL most petitioners are law enforcement officers with relatively few petitions made by others enabled by the law. This is not uncommon in studies of FRO implementation in other jurisdictions.5,8,11 This may reflect lack of community awareness of and/or support for FROs as an option to protect people at risk of harming themselves or others with firearms or other factors such as fear of respondent retaliation. However, a research study by the Ad Council found that the majority of adults polled on FROs were aware and supportive of the policy. 32 Additional local research gaging community support and awareness for FROs would be helpful in further evaluating FRO uptake in Lake County, IL and especially understanding forces that may contribute to low instances of non-law enforcement petitioning.
We found that in Lake County the EFRO petition process generally proceeds within established policy timelines and the majority of cases resulted in firearm removal/FOID card revocation. Two implementation areas identified for further investigation include the low level (7 of 42) of intimate partner notification when an EFRO is petitioned and the volume of EFRO dismissals (10 of 17) due to lack of petitioner appearance at PFRO hearings.
The time elapsed between stages in the process is helpful in accessing how successful FROs are in the timely removal of firearms from those who present danger to themselves and others. In general, EFROS are executed in a timely manner in Lake County with most cases with seizure documentation noting removal on the day of the petition. However, the cases for which data are missing are numerous and suggest a need to improve reporting to better trace outcomes.
Evaluating FRO implementation outcomes is not straight forward. In our study we find that 25 of 42 of EFRO petitions resulted in the issuance of a PFRO; only 1 case was dismissed for lack of cause and 3 dismissed because the cause was not suited to FRO. Overall, these results indicate appropriate use of FRO in that most cases ultimately qualify for the temporary removal of firearms. However, the significant proportion of dismissals due to failure of petitioner to appear at plenary hearings needs further investigation to determine if cause for removal remained despite dismissal.
Additional data sources beyond the mandated court filing system which lacks record of outcomes that occur outside of the progressive process would be helpful. For example, linking court documents to Department of Corrections data, FOID status and death certificates can help us more fully understand FRO implementation and its outcomes. Thorough and thoughtful research exploring FRO implementation and outcomes is needed to build evaluation evidence regarding FRO’s potential for preventing firearm deaths. Longer term assessments will allow for tracing outcomes such as violent injuries and death subsequent to FRO issuance, enable equity analyses, and provide valuable information as to its role in deterring firearm injury and death.
Acknowledgments
We wish to acknowledge the assistance of Dr. Alexander Lundberg in reviewing data for statistical analyses.
Footnotes
ORCID iDs: Maryann Mason
https://orcid.org/0000-0001-6524-1532
Lori Post
https://orcid.org/0000-0002-6261-3254
Sarah Welch
https://orcid.org/0000-0001-5609-3718
Ethical Considerations: This study received human subject research approval from the Northwestern University Institutional Review Board, study number STU00213887.
Consent to Participate: Informed consent to participate has been waived by the Northwestern University Institutional Review Board which deemed that consent would be impractical to obtain.
Consent for Publication: Not applicable.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article:
• Maryann Mason has no conflicts of interest to report.
• Benjamin Katz has no conflicts of interest to report.
• Rachel Jacoby is employed by the Lake County State’s Attorney’s Office.
• Lori Post has no conflicts of interest to report.
• Sarah Welch has no conflicts of interest to report.
Data Availability Statement: Only meta data (aggregate data) can be shared for this study due to the sensitive nature of the data which involve civil court proceedings.
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