PHILADELPHIA—As the number of young people dying by suicide in the United States continues to rise—coupled with the fact that risk for suicide death is much greater with an unlocked, loaded firearm in the home—firearm safety promotion has become a key component of suicide prevention strategies. Now, a grant awarded to the Perelman School of Medicine at the University of Pennsylvania will help improve the implementation of an evidence-based firearm safety program and identify the best approach for deploying this program. The National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), is funding the work with a $3.6 million grant over five years.
“We know that safe gun storage will result in saved lives of young people, and there’s an underused resource which can help provide information on firearm safety—pediatric primary care doctors,” said principal investigator Rinad S. Beidas, PhD, an associate professor of Psychiatry at Penn and director of the Penn Implementation Science Center at the Leonard Davis Institute of Health Economics. Beidas has a personal connection to firearm safety, having lost a family member to suicide by firearm in 2013. “After visiting the pediatrician that same year with my newborn son, I saw a huge opportunity for firearm safety promotion—our doctor asked us about home safety related to car seats and smoke detectors, but not safe firearm storage. Our previous research has shown that both clinicians and parents find firearm safety to be an appropriate topic to discuss in the primary care setting, yet these conversations do not happen routinely.”
This work builds on previously funded research from Beidas and the Mental Health Research Network— a consortium of 14 research centers affiliated with the nation’s largest integrated health systems—where the team gathered feedback from pediatric clinicians, health system leaders, and firearm-owning parents to understand how to best implement Safety Check, an evidence-based firearm safety program. The program involves brief counseling in the pediatric primary care setting and providing a free cable lock to all parents who would like to take one. This approach has been shown to double the odds of self-reported safe firearm storage among parents, but has not been implemented widely. As part of their previous work, the team adapted Safety Check, now called SAFE Firearm, to enhance implementation as a universal suicide prevention strategy.
The research team will study two different approaches for implementing the SAFE Firearm program in pediatric primary care and also evaluate the effectiveness of the program on parental safe firearm storage. The first approach will nudge clinicians to implement the program using the electronic health record (EHR). The second approach will include the nudge in the EHR plus one year of support for the clinics with implementation barriers—such as clinician comfort with discussing firearm safety and helping clinics integrate this program into their workflow. The team hopes to answer whether the EHR-based nudge is powerful enough to effectively implement the program or if facilitation is needed.
The study will include 151 clinicians in 32 clinics who serve 38,989 youth annually in two large health systems in Michigan and Colorado. Results aim to guide future efforts to promote firearm safety as a universal suicide prevention strategy nationally.
“It is an honor to build on thoughtful, partnered work that we have been driving in collaboration with a range of stakeholders over the past five years. Our work would not be possible without the voices of the various experts we have engaged with, including the firearm community,” Beidas said. “This funding provides us with an important opportunity to accelerate our research with the Mental Health Research Network in hopes of achieving our shared mission of keeping youth safe.”
Additional Penn co-investigators include Alison Buttenheim, Shari Jager-Hyman, Kristin Linn, Steven Marcus, Dylan Small, and Courtney Wolk. Other researchers involved include Brian Ahmedani (site lead) and Melissa Maye at Henry Ford Health System and Kaiser Permanente Colorado’s Jennifer Boggs (site lead), Arne Beck, Matthew Daley, and Debra Ritzwoller.
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