Gun Safety 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 CHOP’s Emergency Department (ED) and Primary Care Centers 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 sought out both provider and caregiver perspectives; a study co-authored by CHOP’s Center for Violence Prevention co-director and 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 firearm safety promotion is a health system priority, and also identified important 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 former CHOP Emergency Medicine 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.
Gun safety device distribution is currently underway in CHOP’s ED and three of our Primary Care practices. 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 purchased by CHOP’s Center for Violence Prevention and Department of Community Relations.
If they opt to take a device from primary care, there are follow-ups during subsequent visits. These follow-ups ascertain if and how they are using the safety device and identify facilitators and barriers to use. All participants are also asked to give feedback on the education received, and for their thoughts on this intervention being offered in the pediatric ED and primary care settings.
Long term goals of this collaborative project include reducing the risk of pediatric firearm injury and mortality through widespread education and distribution of safety devices, as well as the development of a model for gun safety education that can be used across a variety of pediatric health care settings.