Adapting the Safety Check Intervention for Wide-Scale Implementation in Health Systems as a universal suicide prevention strategy

This project sought to adapt an evidence-based firearm storage program called Safety Check (Barkin et al., 2008, Pediatrics) to prepare it for use in a hybrid effectiveness-implementation trial targeting universal suicide prevention. This work built on prior work done in a NIMH-funded R21 (MH109878; PI Beidas; 2016-18) in which we partnered with two health systems within the Mental Health Research Network (MHRN), a consortium of 13 US healthcare systems, to better understand how to implement firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. We investigated the acceptability and use of the firearm components of the Safety Check program (screening, counseling, and giving out cable locks) by surveying 140 medical directors and pediatric primary care providers. We subsequently conducted semi-structured interviews with 70 stakeholders, including parents, clinicians, health system leaders, firearm safety course instructors, and firearm owners. We found that pediatric clinicians see firearm safety programs such as Safety Check as acceptable and within scope of practice, but they do not routinely use them. At the same time, we gathered suggested adaptations to the program to target suicide prevention specifically, and a set of stakeholder-recommended implementation strategies to help bridge the gap between clinician beliefs about the importance of firearm safety promotion and low rates of implementation. The strategies include training, leadership endorsement, facilitation to address workflow issues and other barriers, and integration of the program into the electronic health record (EHR). <br> <br>The present project had two specific aims: <br><b><br>Aim 1: To adapt Safety Check using an established adaptation framework (i.e., ADAPT-ITT) and create parent tools to support delivery in collaboration with a stakeholder advisory board.</b> We proposed to adapt Safety Check to optimize its effectiveness for suicide prevention and to create parent and clinician tools to support its delivery and implementation. <br><b><br>Aim 2: To obtain acceptability ratings of the adapted program and delivery tools.</b> We surveyed firearm owning and non-owning parents to garner acceptability ratings of the adapted program.