Gun Lock Distribution Program at CHOP
The prevalence of guns in the U.S. is staggering, particularly when considering health and safety implications for children and families – approximately 4.6 million children and teens live in a home with a loaded, unlocked gun, and research has shown that three out of four kids ages 5–14 know where guns are kept in the home. Additionally, suicide is the second leading cause of adolescent death, with most cases involving a family member’s unlocked gun.
To ensure optimal safety for children in homes with guns, experts at Children’s Hospital of Philadelphia (CHOP) have initiated a program in the CHOP Emergency Department (ED) that allows healthcare providers to have nonjudgmental conversations with families about guns in the home and, if appropriate, offer educational resources and gun safety devices at no cost.
An Evidence-based Approach
CHOP’s approach is research-driven; prior studies in both pediatric practices and community settings have shown that providing firearm safety counseling combined with a safe storage device improves safe storage practices within the home, as opposed to providing safety counseling alone.
CHOP-involved research has also sought out both provider and caregiver perspectives; a study co-authored by Center for Violence Prevention co-director and CHOP emergency medicine physician Joel Fein, MD, MPH assessed the needs of stakeholders who would be involved in implementing an evidence-based approach to firearm safety promotion in pediatric primary care settings. The study revealed that that firearm safety promotion is a health system priority, and also identified important anticipated facilitators and barriers that could be translated from primary care to a program based in an ED.
Prior to the implementation of CHOP’s gun safety education and device distribution program in the ED, the team, led by CHOP Emergency Department Fellow Sofia Chaudhary, MD, conducted qualitative interviews with caregivers for their perspectives on safety device distribution in the pediatric ED setting. While the response to receiving education and a safety device, as well as follow-up to ascertain how the device was being used was favorable, a key suggestion was to make the safety device distribution universal – meaning that families that weren’t willing to disclose firearm ownership would still receive a device. The team followed up the qualitative work with a needs assessment survey of caregivers, finding that 22% of caregivers reported firearm access and, of those, 82% were interested in receiving a gun safety device.
A study of the gun safety device distribution program is currently underway in CHOP’s ED. Caregivers are provided with gun safety education regarding best practice for safe storage of firearms within the home and are encouraged to ask about presence of unlocked guns within homes their children may visit. Those with access to guns within the home are asked if they are interested in receiving a free gun safety device. Participants are offered cable lock safe storage devices that have been donated by the Philadelphia Police Department through Project Child Safe.
If they opt to take a device, there are phone follow-ups at 2 weeks, 2 months, and 6 months to ascertain if and how they are using it and to identify facilitators and barriers to use. All participants are also asked to give feedback on both the education received and thoughts on this intervention being offered in the pediatric ED. Long term goals of this project include reducing the risk of pediatric firearm injury and mortality within the home with wide-spread implementation of gun safety education and safe storage device distribution for the CHOP ED, collaboration with CHOP primary care sites, and development of a model that can be utilized by other pediatric ED programs with similar populations.