Grant Number: 1 R01CE003460-01-00
Project Period: 9/30/2022-9/29/2025
Brief Narrative: Suicide accounts for 60% of U.S. firearm deaths, with even higher rates in Alaska, Colorado, and Washington. Firearms are the most common method of suicide in the U.S., and firearm access is linked to increased suicide risk. Most people who die by suicide see a health care provider in the prior year, including populations at higher risk for suicide such as youth and young adults and Alaska Native and American Indians (AN/AI). Many healthcare systems conduct systematic suicide risk screening; however, systematic screening for firearm access is uncommon, particularly in primary care. Promising clinical practices to prevent firearm suicide also include collaborative discussions about reducing firearm access. Unfortunately, gun ownership is a contentious issue in the U.S, and there is a dearth of evidence available to guide implementation of firearm access assessment and intervention. Our team has been recently addressing this evidence gap. We established that primary care and mental health patients will answer questions about firearms and limiting screening to mental health care recipients misses many at risk patients. We found that concerns about privacy, autonomy, and ownership rights impact patient responses, and we catalogued patient/clinician suggestions for improving assessment and intervention.
This study will build on these findings and address the critical need for patient-centered strategies to identify and engage patients at high-risk of firearm suicide through Objective One of CDC’s RFA-CE-22-004: Research to inform the development of innovative and promising firearm injury/mortality prevention strategies. Human Centered Design and Community Based Participatory Research approaches will support Option B for new data collection activities and the implementation of prevention activities. We will employ CBPR and the Discover, Design and Build, and Test (DDBT) HCD framework to inform implementation strategies in three healthcare systems serving ~1.5 million people in communities with high rates of firearm ownership and suicide. We will:
1 (DISCOVER): Explore stakeholder (patient, clinician, leader) perspectives on clinical practices for identifying and engaging individuals at risk of firearm suicide, and to identify opportunities for practice improvement via retrospective chart review and descriptive analyses of medical records.
2 (DESIGN/BUILD): Partner with clinical and quality improvement staff and leadership to design intervention strategies to support evidence-based clinical practices for firearm suicide prevention.
3 (TEST): Pilot test clinical intervention strategies in three healthcare systems to demonstrate feasibility, acceptability, and usability; and to measure reach for future effectiveness evaluations.
Our work will lay a strong foundation for future dissemination of patient-centered firearm suicide prevention practices and evaluations of effectiveness.
- Lead Site:
- KPWA (PI Julie Richards)
- Participating Sites:
- Southcentral Foundation (co-I Jennifer Shaw)
- KPCO (co-I Jenn Boggs)
Summary of Findings