Safety Behaviors Counseling

Respectful, nonjudgemental conversations about firearm access and secure storage can reduce the risk of injury in the home. Counseling focuses on achievable safety steps and may be paired with providing storage devices to support behavior change.

Violence Domain:

General Firearm Injury
Suicide

Clinical Setting:

Primary Care
Emergency Departments
Specialty Care

Key Staff:

Primary Care Provider
Gerontologist

Delivery Mode:

Clinician-delivered
In-person

Primary Audience:

Universal
Firearm owners
Individuals living in households with firearms
Older adults (ages 65+)
Parents and Caretakers

Primary Outcomes:

Increased adoption of safety behaviors (e.g., utilization of firearm locks or lock boxes, separate storage of ammunition, offsite storage), particularly when administered alongside lock distribution
Decreased risk of suicide
Decreased unauthorized access to firearms
Decreased risk of accidental firearm injuries and death

Safety behaviors counseling is preventative counseling on firearm safety to reduce access to firearms and mitigate related harms. It typically addresses several aspects of firearm-related risk, including firearm access, secure storage practices, and ammunition availability. Usually delivered by a healthcare provider, safety behaviors counseling has been successfully implemented in diverse healthcare settings, including primary care, emergency departments, pediatric clinics, OB-GYN offices, gerontology offices, and more.

The language and approach used for safety behaviors counseling are critical components of its success.¹ It is important to use non-judgmental and neutral language when referring to firearms, with a focus on the health and safety of everyone at home. For example, avoiding terms such as ‘gun control’, ‘assault weapons’, and ‘gun violence’ may increase patient responsiveness to additional counseling and promote behavior change. Language that respects the patient’s decision to own firearms is key to maintaining rapport. Safety behaviors counseling can be offered universally or based on risk screenings. In some cases, assuming there are firearms in the household—instead of asking directly— can reduce defensiveness and facilitate more productive discussions.

The setting and timing may also influence the patient’s responsiveness. For example, initiating firearm safety behaviors conversations in emergency rooms soon after a traumatic event may be strategic, as patients could be more open to behavior change. In pediatric settings, providers may also discuss the different ways children and teens could access firearms and how parents can initiate conversations with relatives or friends about firearm safety.²

Successful counseling emphasizes acceptable and achievable behavior change, with attention to overall household health and well-being. These conversations can lead to behavior changes that limit access to firearms and reduce harms.