Implementing A Secure Firearm Storage Program in Illinois Health Centers in Partnership with AllianceChicago and the Illinois Primary Health Care Association

Northwestern University At Chicago, Evanston IL

Investigators

Abstract

Firearms are now the leading cause of death for young people in the United States. Secure firearm storage programs are evidence-based, low-cost, and scalable. Current efforts to implement these programs primarily occur in ambulatory and acute care settings in largely well-resourced health systems. There is a need to study adaptation and implementation of these programs in community settings including federally qualified health centers (FQHCs) and look-alike safety net health centers. These community settings currently serve 1 in 11 people seeking health care in the United States and prioritize offering services to all areas and populations, thus making them critical partners. In 2023, our team completed the largest hybrid effectiveness-implementation type III trial of its kind (R01 MH123491; “ASPIRE”), in which ~45,000 pediatric well-visits in 30 clinics in two large health systems were eligible to receive S.A.F.E. Firearm, an evidence-based, universal secure firearm storage program that includes a brief conversation between a clinician and parent about secure firearm storage and offering free cable locks. Prior to implementation, clinicians delivered these program components in 2% of well-visits. After clinics and clinicians received training, clinical decision support in the electronic health record, and facilitation, clinicians delivered these program components in 49% of well-visits, representing robust practice change that can save lives. In the proposed study, “COMMUNITY-ASPIRE,” we partner with AllianceChicago, a national practice-based research network, and the Illinois Primary Health Care Association, the state-wide organization for FQHCs, to study the adaptation and implementation of S.A.F.E. Firearm in Illinois FQHCs. In Aim 1, in collaboration with key partners (e.g., clinicians, leaders, parents), we will adapt and optimize S.A.F.E. Firearm and our implementation approach for FQHCs. In Aim 2, we will conduct a pragmatic hybrid type III stepped wedge effectiveness-implementation randomized controlled trial with 12 FQHCs and 720 participants across Illinois to test the effectiveness of our adapted implementation approach (training and facilitation on S.A.F.E. Firearm delivery) on parent-reported receipt of S.A.F.E. Firearm (i.e., reach; primary implementation outcome). We will also assess secondary implementation outcomes (stage of implementation, cost, acceptability) and effectiveness outcomes (parent firearm storage behavior). In Aim 3, we will use mixed methods to identify mechanisms. First, we will conduct interviews to understand constituent perspectives on implementation mechanisms and intervention receipt. Second, we will evaluate reach and firearm storage behavior by participant characteristics. Results will guide future implementation of secure firearm storage programs in FQHCs and prioritize scalability and generalizability. Successful strategies can be taken to scale to save lives, in keeping with the NINR strategic plan.