Healthcare-based solutions to address firearm injuries, whether universally implemented or focused on a specific population or sector, work best when supported by system-wide institutional-level approaches in three key areas:
- Standardized policies and procedures
- Staff and provider training
- Documentation and infrastructure (e.g., electronic health record fields and screening questions).
Policies and Procedures
Clear, consistent policies and procedures help healthcare teams to identify at-risk individuals and provide timely and high-quality care. They also minimize the risk of someone being overlooked or “falling through the cracks.”
Example: Kaiser Permanente Washington included a single question—“Do you have access to guns?”— on standard mental health questionnaires for patients seeking mental health and/or substance use care.1,2
Staff and Provider Training
Training in policies, procedures, and guidelines helps ensure that all staff have the tools and skills needed to provide compassionate and trauma-informed care, recognize risk factors, and deliver evidence-based interventions.3,4 It can also serve to:
- Assess and/or address staff skills, beliefs, and potential biases
- Help to increase staff comfort and confidence in discussing firearms.
This is important because less than one in five family physicians receive any formal firearm safety training during residency. Yet, research shows that simple training sessions — like lectures and workshops — can boost firearm screenings in clinical settings.5 Clinicians have also noted a lack of clear guidelines, fear of offending patients, and insufficient training as barriers to discussing firearm-related risks with patients.6
The Zero Suicide model, a system-wide approach to suicide prevention in clinical settings, recommends that trainings be repeated at least every three years. These can be adapted to support firearm-related interventions and should include:
- An overview of the organization’s mission and vision
- Relevant policies, procedures, and protocols
- Basic, research-informed training for all staff on suicide and risk identification
- Training for clinical staff on how to assess risk, create safety plans, and reduce access to lethal means
- Advanced training to deepen skills and increase confidence7
Documentation and Infrastructure
Firearm-injury prevention interventions can be administered in different ways—during or before the patient’s visit, in person or electronically, and through verbal or written formats. To be effective, internal systems (e.g., paper charts, patient portals, electronic health records) must support standardized data collection, integration of this information into the patients’ records, and easy access to review this information as part of follow-up visits or chart reviews. When building or adapting systems for screenings and interventions, it is important to consider: privacy and confidentiality, respect for patient autonomy, ease of use, and fit within existing systems and processes. In addition, mechanisms for ongoing quality improvement should be in place to assess if interventions, workflows, and procedures are working as intended or if adjustments are needed.