RFA-CE-22-004, Optimizing Firearm Suicide Prevention in Healthcare

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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 year prior to death, thus clinical providers have important opportunities to intervene with patients at risk for firearm suicide. Though firearm access is relevant to patients’ health and safety, routine questions about firearm access are uncommon and there is a dearth of evidence available to guide implementation of promising clinical practices for firearm suicide prevention, including firearm access assessment and provider- initiated dialogue about limiting access. Our team has begun to address this evidence gap in a series of innovative studies focused on firearm access assessment. Specifically, we established that adult primary care and mental health patients will answer standardized questions about firearms, and highlighted how limiting screening questions to patients receiving mental health care misses many at risk patients. We also elicited patient and clinician concerns about firearm access assessment and described how concerns about privacy, autonomy, and ownership rights may be addressed by their suggestions. 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 the Discover, Design and Build, and Test framework to inform implementation strategies in three healthcare systems serving ~1.3 million people in communities with high rates of firearm ownership and suicide. We will: 1 (DISCOVER): Elicit patient, clinician, and 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. Our work will lay a strong foundation for future dissemination of patient-centered firearm suicide prevention practices and evaluations of effectiveness.