Acceptability and Use of Evidence-Based Practices for Safe Firearm Practices in Pediatric Primary Care for Suicide Prevention

Introduction: The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the United States. Safety Check is an evidence-based practice for improving parental firearm safety behavior in pediatric primary care. Safety Check is comprised of three components: (1) screening for the presence of firearms in the home; (2) providing brief counseling about safe firearm storage practices; and (3) providing parents with gunlocks. Despite the evidence supporting this intervention, as well as recommendations from the American Academy of Pediatrics and Institute of Medicine, primary care providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. The NIMH-funded Mental Health Research Network (MHRN), a consortium of healthcare systems across the United States, affords a unique opportunity to better understand acceptability and use of the components of Safety Checkfrom a system-level perspective.

Method: Surveys will be administered to leaders (N = 50) and physicians (N = 200) in 96 pediatric primary care practices (i.e., practices serving children, adolescents, and young adults) within two MHRN systems (Henry Ford Health System [HFHS; Baylor, Scott, & White Health System [BSW]) to understand acceptability and use of the three components of Safety Check(i.e., screening, brief counseling around firearm safety, provision of firearm locks). Data collection will be complete by January, 2017.

Results: Responses from surveys received from 64% of leaders in HFHS confirm that firearms means restriction is rarely discussed with parents during pediatric visits. Practice leaders reported that clinicians in their practices screen for the presence of firearms in the home approximately 30% of the time. Respondents reported that approximately 13% of providers in their practices provide brief counseling around safe firearm storage, and approximately 2% provide gunlocks. All respondents endorsed screening for the presence of firearms and providing brief counseling as acceptable practices, whereas 87% of providers identified the provision of gunlocks as an acceptable intervention. The most commonly reported barrier was lack of time to implement the intervention, followed by anticipated parental discomfort in discussing firearm-related issues. Identified facilitators to promoting means restriction in primary care included: devoted support staff, nurse, or social worker to implement the intervention; staff training; and funding for gunlocks.

Conclusions: This study will provide important insights into current use and acceptability of evidence-based practices for safe firearm practices in pediatric primary care for suicide prevention.