Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy

Wolk, Courtney Benjamin; Pelt, Amelia E. Van; Jager‐Hyman, Shari; Ahmedani, Brian K.; Zeber, John E.; Fein, Joel A.; Brown, Gregory K.; Gregor, Courtney A.; Lieberman, Adina; Beidas, Rinad S.

doi:10.1001/jamanetworkopen.2018.5309

Cited by 34 publications

(27 citation statements)

References 31 publications

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“…Stakeholders were selected using purposive criterion-based sampling to represent different levels of the social ecology of children’s cancer including parent advocates, multidisciplinary health care providers, members/leaders of key pediatric psycho-oncology professional organizations, and leaders in the pediatric healthcare policy [ 20 , 21 ]. Parental stakeholders were considered who had children with cancer.…”

Section: Methodsmentioning

confidence: 99%

“…The key features and contributions of qualitative approaches to engage stakeholders in participatory methods for designing and refining implementation strategies (i.e., gathering process data and explanatory outcome data from which practical ideas can be inductively derived from diverse groups of stakeholders) are well documented [ 18 , 19 ]. Typically, an implementation science framework is used to facilitate data collection from stakeholders and analyze and interpret their data to identify themes and create or modify implementation strategies [ 10 , 20 , 21 ]. Few research reports detail how stakeholder results informed and transformed initial iterations of implementation strategies, particularly in a long-standing program of research focused on health equity.…”

Section: Introductionmentioning

confidence: 99%

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Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

Deatrick

Kazak

Madden

et al. 2021

Implement Sci Commun

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Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

Deatrick

Kazak

Madden

et al. 2021

Implement Sci Commun

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“…Calls to action were recently issued by professional medical associations for physicians to speak out about the public health crisis of firearms . At the same time, research uncovered an imbalance between physician perception of need for patient counseling about firearm safety and the current occurrence of follow‐up in this area . Indeed, although most internist respondents believe it is appropriate for physicians to counsel patients about firearm safety, 77% say they have never discussed these issues with a patient .…”

Section: Discussionmentioning

confidence: 99%

Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide

Morin

Mackin

et al. 2019

J American Geriatrics Society

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OBJECTIVES To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. DESIGN Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012‐2014). SETTING All VA medical centers in the United States. PARTICIPANTS A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. MEASUREMENTS Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records. RESULTS Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain‐Osteoarthritis (30.1%); Depression‐Chronic Pain (22.9%); Depression‐Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain‐Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms. CONCLUSION This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553–2559, 2019

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“…Safety Check was developed using social cognitive theory [64] and uses a harm reduction approach to meet parents where they are with regard to their storage behavior [65,66]. For this study, we will deploy an adapted version of Safety Check which maintains the key components of the original intervention (i.e., counseling and offering a cable lock) [37,67] but extends its reach and acceptability [19,38,41]. Drawing on the ADAPT-ITT framework [42], we collaborated with parents, firearm safety experts, clinicians, and health system leaders [19,38,41,43] to adapt Safety Check to reach a broader age group (i.e., youth < 18) and to serve as a universal suicide prevention strategy in pediatric primary care.…”

Section: Evidence-based Practice/interventionmentioning

confidence: 99%

“…EHRdelivered behavioral economic strategies have been used to change clinician practice in multiple areas of medicine and are highly promising [10,[15][16][17][18]. However, in the case of interventions targeting sensitive topics, such as firearm safety, sexual health behavior, or mental health and substance use, additional strategies may be needed to address clinician and practice factors such as clinician comfort with the intervention or leadership endorsement [19].…”

Section: Introductionmentioning

confidence: 99%

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care

et al. 2021

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Background Insights from behavioral economics, or how individuals’ decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., “Nudge”) powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? Methods The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians’ use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. Discussion The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. Trial registration ClinicalTrials.gov, NCT04844021. Registered 14 April 2021.

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Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy

Cited by 34 publications

References 31 publications

Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care

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