Firearms storage safety discussions in VA primary care: Staff perspectives

Clark, Khaya D.; Newell, Summer; Kenyon, Emily A.; Karras, Elizabeth; Simonetti, Joseph A.; Gerrity, Martha; Dobscha, Steven K.

doi:10.1016/j.genhosppsych.2021.07.007

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…Additional training and education for healthcare providers can facilitate this broader line of inquiry, as well as continued (or increased) use of firearm LMC with women Veterans. Such training is needed given what is known about healthcare providers' lack of knowledge and familiarity with firearms and storage devices [12,58,59], military and firearm cultural competence [60][61][62], and data suggesting that most firearm owners-including Veterans-are open and willing to discuss firearms in certain contexts [63,64]. It is also important for healthcare providers working in settings where women Veterans comprise the majority of patients, such as reproductive health settings [49].…”

Section: Discussionmentioning

confidence: 99%

Women Veterans’ perspectives, experiences, and preferences for firearm lethal means counseling discussions

Polzer,

Holliday,

Rohs

et al. 2023

PLoS ONE

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Aims Firearms have become an increasingly common method of suicide among women Veterans, yet this population has rarely been a focus in firearm suicide prevention research. Limited knowledge is available regarding the preferences, experiences, or needs of women Veterans with respect to firearm lethal means counseling (LMC), an evidence-based suicide prevention strategy. Understanding is necessary to optimize delivery for this population. Method Our sample included forty women Veterans with lifetime suicidal ideation or suicide attempt(s) and firearm access following military separation, all enrolled in the Veterans Health Administration. Participants were interviewed regarding their perspectives, experiences, and preferences for firearm LMC. Data were analyzed using a mixed inductive-deductive thematic analysis. Results Women Veterans’ firearm and firearm LMC perspectives were shaped by their military service histories and identity, military sexual trauma, spouses/partners, children, rurality, and experiences with suicidal ideation and attempts. Half reported they had not engaged in firearm LMC previously. For those who had, positive aspects included a trusting, caring relationship, direct communication of rationale for questions, and discussion of exceptions to confidentiality. Negative aspects included conversations that felt impersonal, not sufficiently comprehensive, and Veterans’ fears regarding implications of disclosure, which impeded conversations. Women Veterans’ preferences for future firearm LMC encompassed providers communicating why such conversations are important, how they should be framed (e.g., around safety and genuine concern), what they should entail (e.g., discussing concerns regarding disclosure), whom should initiate (e.g., trusted caring provider) and where they should occur (e.g., safe spaces, women-specific groups comprised of peers). Discussion This study is the first to examine women Veterans’ experiences with, and preferences for, firearm LMC. Detailed inquiry of the nuances of how, where, why, and by whom firearms are stored and used may help to facilitate firearm LMC with women Veterans.

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Section: Discussionmentioning

confidence: 99%

Women Veterans’ perspectives, experiences, and preferences for firearm lethal means counseling discussions

Polzer,

Holliday,

Rohs

et al. 2023

PLoS ONE

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“…We note that in November 2020, VHA implemented a national mandatory video training session for clinical providers including primary care clinicians. While we see this as an important step and useful resource, based on the knowledge and skills gaps we learned about during our preliminary work with clinical teams, 25 we sought to create a more intensive training experience that included knowledge and skills components. Future research is needed to assess whether the participant-reported gains are sustained over time, and importantly, whether they 1) translate to changes in practice at the provider or clinic level, and 2) ultimately impact patient behaviors and suicide outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The methods and findings from the focus group meetings and individual interviews with veterans and staff have previously been published. [25][26][27] Table 1 shows a summary of findings regarding attitudes and advice given by these stakeholders which specifically informed development of the training program.…”

Section: Development Of the Training Programmentioning

confidence: 99%

“…Would it be okay if we talked about that for a few minutes?" In addition to developing sample scripts for staff to use to guide firearms safety discussions, as was done in the initial analysis of staff and veteran attitudes, [25][26][27] we used a grounded theory approach [32][33][34] to identify candidate learning objectives for the training program and to guide program format.…”

Section: Safety Tipsmentioning

confidence: 99%

“…Our research has demonstrated that both primary care teams and veterans support having FSS discussions during primary care visits, with certain caveats. [25][26][27] The purpose of this manuscript is to 1) describe stakeholderinformed development of an education program to help primary care teams discuss FSS during primary care visits; and 2) present results of a preliminary evaluation of the pilot program.…”

Section: Introductionmentioning

confidence: 99%

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Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Dobscha

Clark

Karras

et al. 2022

Journal of Medical Education and Curricular Development

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Background Reducing access to lethal means is one of the few empirically supported approaches for lowering suicide rates, and safe firearms storage practices have been associated with reduced risk of death by suicide. Although there is substantial opportunity for primary care to assist in addressing lethal means with veterans, approaches to intervention and educating staff are not well documented. We sought to 1) describe development of an education program for primary care teams to help them discuss firearms storage safety (FSS) with veterans during primary care visits; and 2) conduct a preliminary evaluation of the pilot education program. Methods We used an iterative process involving veterans and primary care staff stakeholders to develop program content, format, and supplemental materials. A grounded theory approach was used to analyze data from focus groups and individual interviews. Following piloting of the program with 71 staff members in two primary care clinics, we analyzed pre- and post-training participant surveys of program satisfaction and attitudes comfort related to firearms safety discussions. Results During the development phase, 68 veterans and 107 staff members participated in four veteran focus groups and four primary care focus groups, respectively, and/or individual interviews. The program that was developed, “‘ Just in Case’: Discussing means safety with veterans at elevated risk for suicide,” addresses knowledge and skills learning objectives, and includes video demonstrations and skills practice. Survey data obtained just prior to the pilot training sessions showed low self-reported rates of discussing firearms safety with veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS. Conclusions This interactive knowledge and skill-based means safety curriculum shows promise as a means for educating primary care staff to deliver messaging about firearms safety to veterans. Additional research is needed to refine and evaluate impacts of this or similar training programs on clinician and veteran behaviors over time.

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A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk

Boggs,

Quintana,

Beck

et al. 2024

Prev Sci

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Firearms storage safety discussions in VA primary care: Staff perspectives

Cited by 7 publications

References 25 publications

Women Veterans’ perspectives, experiences, and preferences for firearm lethal means counseling discussions

Women Veterans’ perspectives, experiences, and preferences for firearm lethal means counseling discussions

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk

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