Adapting the Safety Check Intervention for Wide-Scale Implementation in Health Systems for Prevention of Pediatric Firearm Injury and Mortality
Learn more about the project “Adaptation of the Safety Check safe firearm storage program using the ADAPT-ITT framework” presented by Christina Johnson at the Firearm Safety Among Children and Teens (FACTS) symposium, September 23, 2020.
Pediatric visits offer a key opportunity to educate parents about safe firearm storage. Yet few primary care clinicians provide firearm safety interventions, representing a missed opportunity. The Safety Check is promising intervention that includes firearm safety screening, brief counseling, and provision of a cable firearm lock. Pediatric clinicians see firearm safety interventions such as Safety Check as acceptable and within scope of practice, but they do not routinely use them. Adaptations to the Safety Check intervention and stakeholder-recommended implementation strategies may help to bridge the gap between clinician beliefs about the importance of firearm safety promotion and low-rates of implementation. This pilot study will adapt the original Safety Check intervention using an established adaptation framework and create parent and clinician tools to support delivery in collaboration with a stakeholder advisory board. We will use mixed methods approaches with 50 firearm owning parents to understand the feasibility, appropriateness, and acceptability of the adapted Safety Check (to be known as Firearm Safety Check). This pilot project will prepare us to conduct a hybrid effectiveness-implementation trial to test the effectiveness of a) implementation strategies and b) the adapted intervention, the Firearm Safety Check, on implementation (e.g. reach) and clinical outcomes (e.g. safe-safe-storage). This study will lay the groundwork for future large-scale studies to examine the implementation and intervention outcomes for Firearm Safety Check and elucidate the best approaches to large-scale implementation of firearm safety promotion interventions across health systems.
This project aims to conduct a hybrid effectiveness-implementation trial to test the effectiveness of the (a) implementation strategies developed in an NIMH funded R21 (MH109878; PI Beidas; 2016-18) and (b) the adapted intervention, the Firearm Safety Check, on implementation (e.g., reach) and clinical outcomes (e.g., self-reported safe storage). The project team has gathered important information about feasibility and acceptability of both the intervention and implementation strategies through prior work. To be optimally competitive for the proposed trial, the team needs to adapt the intervention and create materials (e.g., videos, pamphlets/handouts) to support parental behavior change, and to create clinician training materials (e.g., video) to support clinician behavior change. The project team will work closely with the FACTS Consortium to put together a stakeholder advisory board to receive ongoing feedback on the materials we are developing to ensure stakeholder input and ecological validity using an established adaptation framework, the ADAPT-ITT model.
Aim 1: To adapt the Safety Check intervention using an established adaptation framework (i.e., ADAPT-ITT) and to create parent tools to support delivery in collaboration with a stakeholder advisory board. This project proposes to adapt the Safety Check to optimize its effectiveness and to create parent and clinician tools to support its delivery and implementation.
Aim 2: To obtain feasibility, appropriateness, and acceptability ratings of the adapted intervention and delivery tools. The project team will survey 50 firearm-owning parents to garner feasibility, appropriateness, and acceptability ratings of the adapted intervention.
The proposed study has the potential to decrease youth firearm injury and mortality and is consistent with NIMH Strategic Priority 4 and NICHD high priority research areas; as well as the American Academy of Pediatrics and Healthy People 2020’s call for reductions in mental illness and violence.
Oregon Health & Science University
University of Colorado
University of Pennsylvania
University of Washington