Feasibility and acceptability of interventions to delay gun access in VA mental health settings

Walters, Heather; Kulkarni, Madhur; Forman, Jane; Roeder, Kathryn; Travis, Jamie; Valenstein, Marcia

doi:10.1016/j.genhosppsych.2012.07.012

Cited by 59 publications

(65 citation statements)

References 19 publications

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“…Screening and counseling about firearms is uncommon, whether as anticipatory guidance (46) or a selective intervention (47)(48)(49). For example, in a study of veterans who screened positive for suicidal thoughts, only 15% of providers documented whether patients had access to firearms (50).…”

Section: Barriersmentioning

confidence: 99%

“…Many barriers exist. Perhaps the most important is clinician unfamiliarity with the benefits and risks of firearm ownership, with what to say during firearm safety counseling and how to say it, and with firearms themselves (41,43,48,(51)(52)(53). It is prudent to avoid areas of practice when one is unfamiliar with the evidence, and in fairness, too little solid evidence exists.…”

Section: Barriersmentioning

confidence: 99%

“…They may feel uncomfortable asking about firearms, even when they are wellinformed (48,51), or worry that patients will not be truthful (48). Some may believe that firearm counseling is outside their scope of practice (51,57) or that discussing firearms could infringe on patients' Second Amendment rights (43,58).…”

Section: Barriersmentioning

confidence: 99%

“…Some may believe that firearm counseling is outside their scope of practice (51,57) or that discussing firearms could infringe on patients' Second Amendment rights (43,58). Fortunately, studies of patient perspectives on firearm counseling have found that most-although certainly not all-patients seem to be open to nonjudgmental education, especially for members of high-risk groups (48,57,59). The American Bar Association has stated that Second Amendment rights are not affected by asking and counseling about firearms (45).…”

Section: Barriersmentioning

confidence: 99%

“…Patients are more open to firearm safety counseling when providers are not prescriptive but focus on well-being and safetyespecially where children are concerned-and involve the family in respectful discussions (48,57). Conversations should acknowledge local cultural norms (57); be individualized (48); and, when possible, occur within (57).…”

Section: How To Ask and Counselmentioning

confidence: 99%

See 4 more Smart Citations

Yes, You Can: Physicians, Patients, and Firearms

Wintemute¹,

Betz²,

Ranney³

2016

Ann Intern Med

136

113

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Section: Barriersmentioning

confidence: 99%

Section: Barriersmentioning

confidence: 99%

Section: Barriersmentioning

confidence: 99%

Section: Barriersmentioning

confidence: 99%

Section: How To Ask and Counselmentioning

confidence: 99%

See 3 more Smart Citations

Yes, You Can: Physicians, Patients, and Firearms

Wintemute¹,

Betz²,

Ranney³

2016

Ann Intern Med

136

113

View full text Add to dashboard Cite

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, Setting, and ParticipantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access (“Do you have access to guns? yes/no”) within the prior 2 weeks. A stratified sampling distribution selected 30% who answered “yes,” 30% who answered “no,” and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main Outcomes and MeasuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and RelevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients’ reasons for firearm access as key to patient-centered practice improvement.

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“Hey, let me hold your guns for a while”: A qualitative study of messaging for firearm suicide prevention

Pallin

Siry-Bove

Azrael

et al. 2019

Behavioral Sci & The Law

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A recommended component of suicide prevention is encouraging at‐risk individuals to voluntarily and temporarily reduce access to firearms and other lethal methods. Yet delivering counseling on the topic can be difficult, given the political sensitivity of firearm discussions. To support such counseling, we sought to identify recommended framing and content of messages about reducing firearm access for suicide prevention. Through qualitative interviews with firearm owners and enthusiasts, we identified key points for use in framing (identity as a gun owner, trust, voluntary and temporary storage, and context and motivation) and specific content (preference for “firearm” over “gun,” and legal issues such as background checks for transfers). These findings build on prior work and should enhance efforts to develop and deliver effective, acceptable counseling and—ultimately—prevent firearm suicide.

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Feasibility and acceptability of interventions to delay gun access in VA mental health settings

Cited by 59 publications

References 19 publications

Yes, You Can: Physicians, Patients, and Firearms

Yes, You Can: Physicians, Patients, and Firearms

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

“Hey, let me hold your guns for a while”: A qualitative study of messaging for firearm suicide prevention

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