Abstract
As the largest integrated health system in New York, it is our organizational mission to address public health
issues such as firearm injury and mortality prevention (FIMP) through healthcare driven protocols (Northwell
Center for Gun Violence Prevention). There is ample justification to use a public health approach for FIMP
within communities. There is a critical need to implement a system-level FIMP strategy to shift the paradigm to
view this as a public health issue with modifiable risk factors the healthcare industry can address as part of
usual care. The objective of this R61 proposal is to develop, implement, and evaluate the feasibility of evidence
based universal screening and intervention among youth and adults at risk firearm injury across pilot
emergency departments (ED) and educate clinical team members about FIMP strategies. Our rationale is that
determining how to implement FIMP strategies into the healthcare setting is central to disseminating
preventative strategies to patients and to provide infrastructure for downstream research. For years, our
Northwell Center for Health Innovations and Outcomes Research has been developing, implementing and
evaluating clinical tools/systems with federal funding. We have implemented multiple system-wide screening
and intervention protocols specific to community health-related issues (e.g. child abuse, human trafficking).
Through our Northwell Screening, Brief Intervention, and Referral to Treatment (SBIRT) program we have laid
the foundation for our system strategy to address substance use as part of usual care in a sensitive, culturally
competent manner and with many cross-cutting themes with FIMP, it will serve as a blueprint for our proposal.
The proposed specific aims are: Aim 1) Use mixed methods to inform the development and implementation of
evidence based: 1a) clinical team member education on FIMP strategies, 1b) universal screening for firearm
injury risk into ED clinical workflows by embedding tools into the electronic health record, and 1c) brief FIMP
intervention (motivational interviewing, education, resources) at the point of care among at-risk youth and
adults to impact modifiable risk factors. We hypothesize that by identifying facilitators, barriers and gaps in
knowledge among clinical team members and patients (pre-implementation surveys), we will design education
to increase knowledge and comfort with FIMP tools and develop FIMP strategies that can be integrated into
usual care. Aim 2: 2a) Pilot the FIMP screening and intervention strategy at 3 ED sites and 2b) conduct a
limited feasibility study evaluating extent of implementation, demand, acceptability and limited efficacy testing
using quasi-experimental designs. We hypothesize that an iterative process incorporating feedback from team
members, stakeholders, and patients/caregivers and analysis of patient screening and follow-up data (pre/post,
interrupted time series), will increase the percentage of patients screened and intervened with better
understanding of the patient experience and characteristics associated with risk and demonstrate improved
safe firearm storage practices.
