Funded Projects

Community Pediatric Firearm Screening and Safety

Project Year

2023

City & State

Worcester, Massachusetts

Program Name

CATCH Resident

Topic

Injury & Violence (LHI)

Program Description

Problem Firearm injury is one of the leading causes of death in children. Homicide by firearms is the second leading cause of death among 15 to 19-year-olds. Suicide by firearms is the third most common cause of death in children aged 10 to 19 years old. There are an estimated 110 unintentional firearm deaths in children 0-14 years old each year. Importantly, about 85% of firearm deaths among children younger than 12 years old occur at home. In Massachusetts, adolescents are overrepresented in the firearm death rate, with over 38% of firearm deaths occurring among those aged 15-24 years, despite this age group comprising almost a quarter of the population. The medical costs of pediatric firearm violence exceed $330 million per year, not to mention the traumatic toll these injuries and deaths take on families and communities. The 2022 AAP policy statement “Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction” identifies the importance of firearm anticipatory guidance and safe gun storage education as part of routine patient visits. In 2002, a survey of pediatric residents demonstrated universal opinion that physicians should discuss firearm safety. Barriers included a lack of training, proper materials, and prompting by attendings. Only 10% of residents reported counseling all patients and 30% spoke with a quarter or none of their patients about firearm safety. This study is now over 20 years old and does not reflect the current landscape of the firearms epidemic nor the now ubiquitous pediatric mental health crisis. Primary setting We will be focusing on pediatricians’ offices in Central Massachusetts. In addition, we plan to provide resources to local gun shops, law enforcement agencies and community centers. Number of children affected This project focuses on children in Central Massachusetts. According to the 2020 census, in Worcester county there is a total population of 862,111, 20.7% being under the age of 18 years (~178,000). Project goal This project seeks to understand community pediatrician practices and barriers surrounding firearms safety screening and counseling through the use of quantitative and qualitative methods. The insights gained will guide the implementation of actionable interventions that are community-informed and highly acceptable in the community pediatric primary care setting. Proposed intervention We have two primary aims, focusing on planning and implementation. 1) Planning: We will engage with community pediatricians via a survey as well as focus groups to obtain qualitative and quantitative data regarding firearm safety screening and counseling practices. We will investigate barriers to screening and counseling, as well as seek ideas about how to most effectively implement our primary interventions, as below. 2) Implementation: Our three primary interventions to improve firearm safety in the community include: (a) Providing trigger locks to pediatricians’ offices and community locations for distribution. (b) Creating and providing access to a physical and/or virtual firearm storage map identifying temporary and voluntary storage locations in times of crisis. (c) Fostering a bolstered connection between pediatricians and the UMass Injury Prevention Center. Among their various programs, they sponsor an annual firearm buyback program in Worcester. We aim to solidify the relationship between pediatricians and community partners with the Injury Prevention Center, so it will serve as a year-round, sustainable resource. Anticipated outcomes We seek to increase firearm screening and counseling practices, which will be measured through a post-intervention survey. We will increase access to interventions for firearm-owning families, specifically trigger locks and emergency storage maps. We will track the number of trigger locks distributed, as well as maps distributed and accessed online. Fostering collaboration between pediatricians and the Injury Prevention Center will help sustain these interventions over time.

Project Goal

Increase the rates of firearm safety screening and counseling among local pediatricians at well child visits and provide them with acceptable, actionable interventions (trigger locks and emergency storage maps) for patients with firearms in the home.

Project Objective 1

By providing primary care providers with information regarding firearm storage safety, improve self-reported rates of firearm ownership assessment and safety counseling to at least 50% at well child visits in local pediatric primary care offices over a 12-month period.

Project Objective 2

Assess the number of firearm trigger locks distributed to firearm owners by pediatricians during well child visits over a 6-month period; aim for 50% overall distribution.

Project Objective 3

Assess the number of visits to an online emergency firearm safe storage map, as well as the number of physical maps, distributed to firearm owners by pediatricians during well child visits over a 6-month period; aiming for at least 150 clicks over the course of this period.

AAP District

District I

Institutional Name

UMass Chan Medical School

Contact 1

Alison Casserly

Contact 2

Samantha Rosenblum