Gun Safety Program Proposed for Pediatric Primary Care to Curb Youth Suicide

Firearm Safety Check features screening for the presence of guns in the home, counseling about safe firearms storage, and distribution of free gun locks.

Firearm safety programs in pediatric primary care such as screening for the presence of guns in the home can serve as an effective youth suicide prevention strategy, recent research indicates.

Suicide is the second leading cause of death for people 10 to 24 years old, and guns are the most common means of these deaths, according to the Centers for Disease Control and Prevention. There is an opportunity to curb youth suicide in the primary care setting—more than three-quarters of youths who commit suicide visit pediatric primary care in the year before their deaths.

Firearm Safety Check—a program that features screening for the presence of guns in the home, counseling about safe firearm storage, and distribution of free firearm locks—can be deployed in pediatric primary care and save lives, researchers wrote recently in Journal of the American Medical Association.

The proposal does not run counter to the National Rifle Association's recent call for physicians to abstain from participating in debates about gun policy, a co-author of the JAMA research told HealthLeaders this week.

"We can all agree to a shared agenda on saving kids' lives. To move the needle on this public health crisis, we need to partner and take multiple approaches toward promoting firearm safety. That includes firearm owners and experts, healthcare clinicians, parents, and other community members. I see Firearm Safety Check as one approach to moving the needle," said Rinad Beidas, PhD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Stakeholder views
 

The research team interviewed 58 stakeholders, including parents, physicians, nurses and nurse practitioners, leaders of pediatric primary care practices, behavioral health staff, health system leaders, and payers. The stakeholders, who included gun owners, said firearm safety should be a health system priority.

• The stakeholders said most patients and families would have a positive view of Firearm Safety Check
   
• The patients served by the two health systems that participated in the research featured both inner city youth who had firearms in the home for protection as well as suburban and rural youth who had firearms in the home for hunting and recreation
   
• Stakeholders said inner city families could be more receptive to Firearm Safety Check because of the free provision of safety locks
   
• Many stakeholders said U.S. gun culture could impact implementation of Firearm Safety Check, with some families feeling gun ownership screening violates their Second Amendment rights

Implementation strategies
 

In general, stakeholders suggested implementing Firearm Safety Check in pediatric primary care with medical assistants and nurses screening patients for gun ownership and distributing locks, and physicians counseling gun safety during wellness visits.

Clinician stakeholders had mixed views on Firearm Safety Check implementation, the researchers wrote. "Some clinicians stated they lacked expertise around firearm locks and wanted additional training. While many clinicians said that it was important and within their scope of practice to facilitate conversations about firearms, some reported feeling uncomfortable."

The stakeholders identified six primary implementation strategies.

• Stakeholders said Firearm Safety Check should be launched across entire health systems with the support of system leadership to ensure key implementation elements such as funding for gun locks
   
• Screening for gun ownership was called feasible, and stakeholders suggested screening should be brief, done during wellness visits, and incorporated with other screening questions such as bike helmet usage
   
• Clinicians said counseling about safe gun storage would be feasible if the interaction lasted less than 1 minute
   
• Stakeholders said distribution of gun locks was the most problematic element of Firearm Safety Check, with concerns such as financing of free gun locks and clinician apprehension about teaching proper use of the devices
   
• Stakeholders called for integrating Firearm Safety Check into health system EMRs to trigger reminders about screening and for ongoing monitoring
   
• Staff training was recommended to ensure effective management of Firearm Safety Check, with education sessions set for standard sessions such as monthly clinical meetings

Health systems should explore partnerships and other creative approaches to launching and sustaining Firearm Safety Check, the researchers wrote.

"Additional implementation strategies identified included a policy mandate and exploring creative financing. These included partnering with local police, gun shops, and/or firearm safety programs, applying for grants, and working with private payers and insurers to cover the cost of locks."