P3.K210: Integrating Firearm Safety Counseling and Lock Distribution into Clinical Care

Background: Firearms are the leading cause of death for children nationwide, and pediatric health care providers are in a unique position to intervene. Studies show that access to firearms in the home puts youth at high risk for suicide and unintentional shootings, and that coupling safer firearm storage counseling with distribution of free locking devices can have significant impact. As millions of children across the country live in homes with firearms, the majority of which are not stored securely, it is critical to integrate this proven solution to youth firearm injury and fatality into pediatric care.

Project Description: In July 2023, the Children’s Hospital of Philadelphia (CHOP) Center for Violence Prevention’s Gun Safety Program received a two-year award from the Department of Pediatrics to integrate firearm safety counseling and free locking device distribution into clinical care. This initiative provides salary support and creates the opportunity to prioritize hospital resources such as information systems, quality improvement, central supply, web design, and communications. The goal is to create a scalable, systemic workflow that is standardized and evidence-based while remaining flexible enough for integration into a range of health care settings.

Discussion: This initiative draws from key aspects of two programs originating in CHOP’s Emergency Department (ED) and primary care practices. Firearm screening occurs in the ED via mandatory social work assessments for patients with behavioral health concerns, and in three primary care practices via an electronic health record prompt built into annual well-visits. Since inception, screening has occurred at an average of 54.90% of eligible primary care visits and 97.60% of eligible ED visits. Cable locks have been distributed at a total of 1,173 encounters.

As a first step towards widespread expansion, these two programs were aligned in terms of language, documentation, and data collection tools. Also newly developed and closely aligned is an innovative, parent/guardian-facing pre-visit questionnaire. Utilizing this range of refined and standardized tools, enterprise-wide expansion is underway in additional primary care practices, several inpatient units, and subspecialty and ambulatory behavioral health locations. Training in safe firearm storage has occurred for 352 physicians, advanced practice providers, nurses, and social workers who practice across these settings. In pre-implementation surveys, 100% of respondents from primary care and the pediatric residency program, and 93% of respondents from ambulatory health and the Pediatric Intensive Care Unit, welcome a firearm safety initiative in their practice.

Conclusion: CHOP’s Center for Violence Prevention has developed a large-scale, evidence-based firearm safety program that is standardized yet adaptable to a range of health care settings. These results call for health systems to address youth access to firearms and provide safe storage education and locking devices to curtail the public health toll associated with preventable firearm injury and death.