A team that includes several CHIBE members has won an R01 from the National Institute of Mental Health (NIMH) to test strategies to increase implementation of a universal safe firearm storage program in pediatric primary care.
Previous research has shown that the pediatric primary care setting is well-suited to incorporate universal prevention to reduce firearm access and suicide risk. One reason is because youth access care in this setting; in fact, one study found that more than three-quarters of youth who died by suicide had accessed primary care in the prior year. In addition, previous research has shown that primary care interventions can be effective at increasing safe firearm storage among parents.
While the American Academy of Pediatrics and the National Academy of Medicine recommend interventions to promote universal safe firearm storage, there is a need for implementation research to determine how to embed evidence-based practices in routine clinical practice.
The current proposal for this work builds on an NIMH-funded R21 conducted in the Mental Health Research Network (MHRN) and will incorporate findings gleaned from interviews with 70 stakeholders. The team will work with 32 clinics, 151 clinicians, and 38,989 youth in two MHRN systems in Michigan and Colorado. These clinics will be randomized to receive either an EHR implementation strategy (nudge) or the EHR implementation strategy plus 1 year of facilitation to target implementation barriers (nudge+).
What drew you to study firearm safety in pediatric primary care?
In 2013, we lost a family member to suicide by firearm. After visiting the pediatrician that same year with our newborn son and having our doctor ask us about home safety related to car seats, smoke detectors, and safe sleep, but not firearm safe storage, I realized that there might be an opportunity to engage in firearm safety promotion discussions at the doctor’s office. After reviewing the literature, I learned there was an evidence-based practice that had been tested in a large trial that was not frequently implemented. This led me down the path of this work!
Why is this work so important to pursue?
In the United States, the suicide rate for young people has been increasing over the past decade. In 2016, the suicide death rate in young people was 6 per 100,000 and approximately half of those deaths were with a firearm. Based on survey and simulation research, we know that increasing safe firearm storage in the community could save the lives of young people.
This work represents the input of many diverse stakeholders and a shared mission to keep kids safe. I’m so excited to have the chance to build upon our previously funded research and to test a set of strategies to increase use of an evidence-based safe firearm storage program in pediatric primary care as a universal suicide prevention strategy in collaboration with two large health systems. This work has the potential to help us understand how to respectfully and effectively implement safe firearm storage programs nationally and to save lives.
How will you leverage behavioral science in this project?
We are testing a nudge in the electronic health record (EHR) vs. a nudge plus facilitation, which addresses clinic-specific implementation barriers to the program. We hope to answer the primary question: Is the less costly and scalable EHR-based nudge powerful enough or is more intensive and expensive facilitation needed to overcome implementation barriers in the case of this sensitive intervention?
The entire investigative team is composed of (CHIBE member are bolded): Rinad Beidas, PhD; Jennifer Boggs, PhD; Arne Beck, PhD; Brian Ahmedani, PhD; Alison Buttenheim, PhD, MBA; Kristin Linn, PhD, MStat; Steven Marcus, PhD; Dylan Small, PhD; Debra Ritzwoller, PhD; Shari Jager-Hyman, PhD; Courtney Wolk, PhD; Matthew Daley, MD; and Melissa Maye, PhD.
Associate Professor of Psychiatry, Medical Ethics and Health Policy, Medicine, Perelman School of Medicine
Associate Director, CHIBE
Assistant Professor of Biostatistics, University of Pennsylvania
Class of 1965 Professor of Statistics, Wharton School