Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study

Courtney Benjamin Wolk, Shari Jager-Hyman, Steven C Marcus, Brian K Ahmedani, John E Zeber, Joel A Fein, Gregory K Brown, Adina Lieberman, Rinad S Beidas, Courtney Benjamin Wolk, Shari Jager-Hyman, Steven C Marcus, Brian K Ahmedani, John E Zeber, Joel A Fein, Gregory K Brown, Adina Lieberman, Rinad S Beidas

Abstract

Introduction: The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care.

Methods and analysis: The National Institute of Mental Health-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the USA, affords a unique opportunity to better understand how to implement a firearm safety intervention in paediatric primary care from a system-level perspective. We will collaboratively develop implementation strategies in partnership with MHRN stakeholders. First, we will survey leadership of 82 primary care practices (ie, practices serving children, adolescents and young adults) within two MHRN systems to understand acceptability and use of the three firearm components of Safety Check (ie, screening, brief counselling around firearm safety and provision of firearm locks). Then, in collaboration with MHRN stakeholders, we will use intervention mapping and the Consolidated Framework for Implementation Research to systematically develop and evaluate a multilevel menu of implementation strategies for promoting firearm safety as a suicide prevention strategy in paediatric primary care.

Ethics and dissemination: Study procedures have been approved by the University of Pennsylvania. Henry Ford Health System and Baylor Scott & White institutional review boards (IRBs) have ceded IRB review to the University of Pennsylvania IRB. Results will be submitted for publication in peer-reviewed journals.

Keywords: adolescent; firearms; implementation; intervention mapping; means restriction; suicide.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study guiding framework. Figure adapted from Damschroder. CFIR, Consolidated Framework for Implementation Research.

References

    1. Curtin SC, Warner M, Hedegaard H. Increase in Suicide in the United States, 1999-2014. NCHS Data Brief 2016:1-8.
    1. National Center for Health Statistics. 10 leading causes of death by age group, United States (2014). Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2014.
    1. Miller M, Azrael D, Barber C. Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide. Annu Rev Public Health 2012;33:393–408.10.1146/annurev-publhealth-031811-124636
    1. Hepburn L, Miller M, Azrael D, et al. . The US gun stock: results from the 2004 national firearms survey. Inj Prev 2007;13:15–19.10.1136/ip.2006.013607
    1. Kalesan B, Villarreal MD, Keyes KM, et al. . Gun ownership and social gun culture. Inj Prev 2016;22:216–20.10.1136/injuryprev-2015-041586
    1. Barber CW, Miller MJ. Model for estimating reduction in U.S. suicide deaths following a reduction in suicidal adult persons’ access to firearms. Rockville, MD:National Institute of Mental Health and Research Prioritization Task Force, 2014.
    1. Kreitman N. The coal gas story. United Kingdom suicide rates, 1960-71. Br J Prev Soc Med 1976;30:86–93.10.1136/jech.30.2.86
    1. Gunnell D, Middleton N, Frankel S. Method availability and the prevention of suicide--a re-analysis of secular trends in England and Wales 1950-1975. Soc Psychiatry Psychiatr Epidemiol 2000;35:437–43.10.1007/s001270050261
    1. Gunnell D, Fernando R, Hewagama M, et al. . The impact of pesticide regulations on suicide in Sri Lanka. Int J Epidemiol 2007;36:1235–42.10.1093/ije/dym164
    1. Lubin G, Werbeloff N, Halperin D, et al. . Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide Life Threat Behav 2010;40:421–4.10.1521/suli.2010.40.5.421
    1. Mann JJ, Michel CA. Prevention of firearm suicide in the United States: what works and what Is possible. Am J Psychiatry 2016;173:969–79.10.1176/appi.ajp.2016.16010069
    1. Webster DW, Vernick JS, Zeoli AM, et al. . Association between youth-focused firearm laws and youth suicides. JAMA 2004;292:594–601.10.1001/jama.292.5.594
    1. Barber CW, Miller MJ. Reducing a suicidal person's access to lethal means of suicide: a research agenda. Am J Prev Med 2014;47(3 Suppl 2):S264–72.10.1016/j.amepre.2014.05.028
    1. Hogan MF, Grumet JG. Suicide prevention: an emerging priority for health care. Health Aff 2016;35:1084–90.10.1377/hlthaff.2015.1672
    1. Glenn CR, Franklin JC, Nock MK. Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. J Clin Child Adolesc Psychol 2015;44:1–29.10.1080/15374416.2014.945211
    1. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 2002;159:909–16.10.1176/appi.ajp.159.6.909
    1. Husky MM, Olfson M, He JP, et al. . Twelve-month suicidal symptoms and use of services among adolescents: results from the National Comorbidity Survey. Psychiatr Serv 2012;63:989–96.10.1176/appi.ps.201200058
    1. Klein JD, Wilson KM, McNulty M, et al. . Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. J Adolesc Health 1999;25:120–30.10.1016/S1054-139X(98)00146-3
    1. Barkin SL, Finch SA, Ip EH, et al. . Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics 2008;122:e15–e25.10.1542/peds.2007-2611
    1. Dowd MD, Sege RD. Council on Injury, Violence, and Poison Prevention Executive Committee American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics 2012;130:e1416–23.10.1542/peds.2012-2481
    1. Leshner AI, Altevogt BM, Lee AF, et al. . Priorities for research to reduce the threat of firearm-related violence. Washington, DC: Institute of Medicine and National Research Council, 2013.
    1. Roszko PJ, Ameli J, Carter PM, et al. . Clinician attitudes, screening poractices, and interventions to reduce firearm-related injury. Epidemiol Rev 2016;38:mxv005–110.10.1093/epirev/mxv005
    1. Betz ME, Wintemute GJ. Physician counseling on firearm safety: a new kind of cultural competence. JAMA 2015;314:449–50.10.1001/jama.2015.7055
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50.10.1186/1748-5908-4-50
    1. Tabak RG, Khoong EC, Chambers DA, et al. . Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 2012;43:337–50.10.1016/j.amepre.2012.05.024
    1. Finch SA, Weiley V, Ip EH, et al. . Impact of pediatricians' perceived self-efficacy and confidence on violence prevention counseling: a national study. Matern Child Health J 2008;12:75–82.10.1007/s10995-007-0223-2
    1. Ozer EM, Adams SH, Gardner LR, et al. . Provider self-efficacy and the screening of adolescents for risky health behaviors. J Adolesc Health 2004;35:101–7.10.1016/S1054-139X(03)00536-6
    1. Maiuro RD, Vitaliano PP, Sugg NK, et al. . Development of a health care provider survey for domestic violence: psychometric properties. Am J Prev Med 2000;19:245–52.10.1016/S0749-3797(00)00230-0
    1. Cheng TL, DeWitt TG, Savageau JA, et al. . Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med 1999;153:629–35.
    1. Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med 2016;165:205–13.10.7326/M15-2905
    1. Betz ME, Ranney ML, Wintemute GJ. Physicians,patients and firearms: the courts say "yes" [published online March 7 2017]. Ann Intern Med 2017.
    1. Schaafsma D, Stoffelen JM, Kok G, et al. . Exploring the development of existing sex education programmes for people with intellectual disabilities: an intervention mapping approach. J Appl Res Intellect Disabil 2013;26:157–66.10.1111/jar.12017
    1. Belansky ES, Cutforth N, Chavez R, et al. . Adapted intervention mapping: a strategic planning process for increasing physical activity and healthy eating opportunities in schools via environment and policy change. J Sch Health 2013;83:194–205.10.1111/josh.12015
    1. Fernández ME, Gonzales A, Tortolero-Luna G, et al. . Using intervention mapping to develop a breast and cervical cancer screening program for Hispanic farmworkers: Cultivando La Salud. Health Promot Pract 2005;6:394–404.10.1177/1524839905278810
    1. Hurley DA, Murphy LC, Hayes D, et al. . Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS). Implement Sci 2016;11:56.10.1186/s13012-016-0418-2
    1. Bartholomew LK, Parcel G, Gottlieb NH. Intervention mapping: designing theory and evidence-based health promotion programs. Mountain View, CA: Mayfield Publishing, 2001.
    1. Waltz TJ, Powell BJ, Chinman MJ, et al. . Expert Recommendations for Implementing Change (ERIC): protocol for a mixed methods study. Implement Sci 2014;9:39.10.1186/1748-5908-9-39
    1. Bridge JA, Asti L, Horowitz LM, et al. . Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. JAMA Pediatr 2015;169:673.10.1001/jamapediatrics.2015.0465
    1. Texas Legisislature. An act relating to prohibiting certain physician questions regarding firearms. HB 2823 2823, 2015.
    1. Fontanella CA, Hiance-Steelesmith DL, Phillips GS, et al. . Widening rural-urban disparities in youth suicides, United States, 1996-2010. JAMA Pediatr 2015;169:466–73.10.1001/jamapediatrics.2014.3561
    1. Pellecchia M, Connell JE, Beidas RS, et al. . Dismantling the active ingredients of an intervention for children with autism. J Autism Dev Disord 2015;45:2917–27.10.1007/s10803-015-2455-0
    1. Rahm AK, Boggs JM, Martin C, et al. . Facilitators and barriers to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care in integrated health care settings. Subst Abus 2015;36:281–8.10.1080/08897077.2014.951140
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13.
    1. Bartholomew L, Markham CM, Ruiter RAC, et al. . Planning health promotion programs: an intervention mapping approach. San Francisco, CA: Jossey-Bass, 2016.
    1. Palinkas LA, Horwitz SM, Green CA, et al. . Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015;42:533–44.10.1007/s10488-013-0528-y
    1. Hays DG, Singh AA. Qualitative inquiry in clinical and educational settings. New York, NY: The Guilford Press, 2012.
    1. Palinkas LA, Aarons GA, Horwitz S, et al. . Mixed method designs in implementation research. Adm Policy Ment Health 2011;38:44–53.10.1007/s10488-010-0314-z
    1. Aarons GA, Palinkas LA. Implementation of evidence-based practice in child welfare: service provider perspectives. Adm Policy Ment Health 2007;34:411–9.10.1007/s10488-007-0121-3
    1. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 2007;42:1758–72.10.1111/j.1475-6773.2006.00684.x
    1. Bandura A. Human agency in social cognitive theory. Am Psychol 1989;44:1175–84.10.1037/0003-066X.44.9.1175
    1. Fishbein M. Developing effective behavior change interventions: some lessons learned from behavioral research. NIDA Res Monogr 1995;155:225–46.
    1. Curran GM, Bauer M, Mittman B, et al. . Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012;50:217–26.10.1097/MLR.0b013e3182408812
    1. Johnson RM, Frank EM, Ciocca M, et al. . Training mental healthcare providers to reduce at-risk patients' access to lethal means of suicide: evaluation of the CALM Project. Arch Suicide Res 2011;15:259–64.10.1080/13811118.2011.589727
    1. Yip PS, Caine E, Yousuf S, et al. . Means restriction for suicide prevention. Lancet 2012;379:2393–9.10.1016/S0140-6736(12)60521-2
    1. Donaldson A, Poulos RG. Planning the diffusion of a neck-injury prevention programme among community rugby union coaches. Br J Sports Med 2014;48:151–9.10.1136/bjsports-2012-091551
    1. Donaldson A, Lloyd DG, Gabbe BJ, et al. . We have the programme, what next? Planning the implementation of an injury prevention programme. Injury Prevention 2016:injuryprev-2015-041737–8.10.1136/injuryprev-2015-041737
    1. Evans D, Mellins R, Lobach K, et al. . Improving care for minority children with asthma: professional education in public health clinics. Pediatrics 1997;99:157–64.10.1542/peds.99.2.157
    1. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 2010;31:399–418.10.1146/annurev.publhealth.012809.103604
    1. Kok G, Schaalma H, Ruiter RA, et al. . Intervention mapping: protocol for applying health psychology theory to prevention programmes. J Health Psychol 2004;9:85–98.10.1177/1359105304038379
    1. Barber C, Frank E, Demicco R. Reducing suicides through partnerships between health professionals and gun owner groups-beyond docs vs glocks. JAMA Intern Med 2017;177:5–6.10.1001/jamainternmed.2016.6712
    1. Betz ME, Azrael D, Barber C, et al. . Public opinion regarding whether speaking with patients about firearms is appropriate. Ann Intern Med 2016;165:543.10.7326/M16-0739
    1. Damschroder L. Advanced topics for implementation science research: pragmatic application and scientific advancement of the consolidated frame work for implementation research (CFIR) Advanced Topics in Implementation Science (IS) Research Webinar Series.

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