HEALTH SYSTEMS INTERVENTIONS
TO PREVENT FIREARM INJURIES
AND DEATH
PROCEEDINGS OF A WORKSHOP
Joe Alper, Melissa French, and Alexis Wojtowicz, Rapporteurs
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the American Hospital Association and Kaiser Permanente. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48839-6
International Standard Book Number-10: 0-309-48839-7
Digital Object Identifier: https://doi.org/10.17226/25354
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Copyright 2019 by the National Academy of Sciences. All rights reserved.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Health systems interventions to prevent firearm injuries and death: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25354.
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PLANNING COMMITTEE ON HEALTH SYSTEMS INTERVENTIONS TO PREVENT FIREARM INJURIES AND DEATH1
GEORGE J. ISHAM (Chair), Senior Fellow, HealthPartners Institute
DAVID BRENT, Academic Chief, Child and Adolescent Psychiatry, Endowed Chair in Suicide Studies, Western Psychiatric Institute and Clinic; Professor of Psychiatry, Pediatrics, Epidemiology and Clinical Translational Science, University of Pittsburgh School of Medicine
CARNELL COOPER, Founder, Violence Intervention Program; Adjunct Professor of Surgery, University of Maryland School of Medicine; and Chief Medical Officer, Northeast Methodist Hospital, San Antonio, Texas
JOEL A. FEIN, Professor of Pediatrics and Emergency Medicine, University of Pennsylvania Perelman School of Medicine; Co-Director, Children’s Hospital of Philadelphia Violence Prevention Initiative; and Research Co-Director, National Network of Hospital-Based Violence Intervention Programs
STEPHEN HARGARTEN, Director, Comprehensive Injury Center; Professor of Emergency Medicine, Medical College of Wisconsin
THEA L. JAMES, Associate Professor of Emergency Medicine, Associate Chief Medical Officer, Vice President of Mission, and Director of the Violence Intervention Advocacy Program, Boston Medical Center
LUCAS P. NEFF, Assistant Professor of Pediatric Surgery, Wake Forest University Baptist Medical Center
JOHN A. RICH, Professor of Health Management and Policy, and Director, Center for Nonviolence and Social Justice, Drexel University School of Public Health
THERESE S. RICHMOND, Andrea B. Laporte Professor, Associate Dean for Research and Innovation, University of Pennsylvania School of Nursing; Penn Injury Science Center
ALI ROWHANI-RAHBAR, Bartley Dobb Professor for the Study and Prevention of Violence, Associate Professor of Epidemiology, and Pediatrics, Violence Prevention Section Leader at Harborview Injury Prevention and Research Center, University of Washington
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
Health and Medicine Division Staff
MELISSA G. FRENCH, Senior Program Officer
ALEXIS WOJTOWICZ, Research Associate
ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ANTONIA M. VILLARRUEL, University of Pennsylvania School of Nursing. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Contents
Organization of the Proceedings
2 WHY DO HEALTH SYSTEMS HAVE A ROLE?
Gun Violence: A Complex Biopsychosocial Disease Requiring a Strengthened Health Care System Response
3 THE TOLL ON INDIVIDUALS AND COMMUNITIES
A Pediatric Victim and Opportunities the Health System Had to Intervene
The Psychological and Social Burden of Firearm Violence on Communities
4 IDENTIFYING INDIVIDUALS AT HIGHER RISK FOR FIREARM VIOLENCE
Identifying Survivors of Domestic Violence Who Are at High Risk for Firearm-Related Violence
Applying a Medical Model of Disease to Identify Those at Risk of Firearm Violence
Factors to Consider When Thinking About Identifying Risk of Firearm Violence
5 DEVELOPING HEALTH SYSTEM INTERVENTIONS
Developing a Firearm Storage Decision Aid to Enhance Counseling on Access to Lethal Means
Creating Consensus: Developing a Firearm Injury Research Agenda
6 KEY ISSUES FROM THE WORKSHOP’S FIRST DAY
Getting Health Systems Involved
Helping Providers with the Aftermath of Gun Violence
Helping Health System Leaders Act
Helping Individuals with Firearm Injuries Clinical Trial
SafERteens: An Evidence-Based Youth Violence Prevention Program
Participatory Approaches to Implementing Firearm Safety Promotion in Pediatric Primary Care
State of the Science for Hospital-Based Violence: Research and Policy Implications
8 DEVELOPING NETWORKS AND SHARING INFORMATION
Building a Learning Health Care System for Suicide Prevention
Violence Intervention and Collaboration
9 DEVELOPING A CULTURE OF HEALTH CARE PROVIDERS AS INTERVENERS
Hospitals Against Violence Initiative
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Box, Figures, and Tables
BOX
2-1 Antecedents of Homicide and Suicide Death
FIGURES
3-1 Leading causes of pediatric deaths in trauma centers in the United States (2010–2016)
3-2 Pediatric trauma case fatality rate in trauma centers in the United States (2010–2016)
3-3 Pediatric firearm injury data from Atlanta by age and race (2005–2015)
3-4 Urban and rural shifts in intentional firearm deaths
3-5 Pathways to recurrent trauma among young African American men
4-1 Haddon Matrix applied to firearm violence
5-1 Funding of research on gun violence and other leading causes of death
5-2 In-hospital case fatality rate for traumatic injuries
7-1 Project Ujima summer camp improves patient-reported outcomes
7-2 Organization of the Firearm Safety Among Children and Teens (FACTS) consortium
7-3 The many traumas that occur before and after a violent injury
9-1 A framework for creating a health system to prevent violence
10-1 Leading causes of pediatric deaths in trauma centers in the United States (2010–2016)
TABLES
3-1 Likelihood of Gun Violence in a Person’s Social Network, 2013
3-2 Firearm-Related Homicides and Suicides per 100,000 Individuals in Three Communities
7-2 Suffering a Gunshot Wound Increases the Risk of Getting Shot Again
7-3 Federal Funding of Firearm Research and Number of Deaths Compared to Other Disorders
Acronyms and Abbreviations
AAP | American Academy of Pediatrics |
ACA | Patient Protection and Affordable Care Act |
ACEP | American College of Emergency Physicians |
AFFIRM | American Foundation for Firearm Injury Reduction in Medicine |
AHA | American Hospital Association |
CALM | Counseling on Access to Lethal Means |
CDC | Centers for Disease Control and Prevention |
CTI | critical time intervention |
DLIVE | Detroit Life Is Valuable Everyday |
EHR | electronic health record |
ERPO | extreme risk protective order |
FACTS | Firearm Safety Among Children and Teens consortium |
HAV | Hospitals Against Violence |
HIPAA | Health Insurance Portability and Accountability Act |
HVIP | hospital-based violence intervention program |
IOM | Institute of Medicine |
IPV | intimate partner violence |
NIMH | National Institute of Mental Health |
NNHVIP | National Network of Hospital-Based Violence Intervention Programs |
NRC | National Research Council |
PHQ-9 | Patient Health Questionnaire-9 |
USPSTF | U.S. Preventive Services Task Force |
VA | Department of Veterans Affairs |
VHA | Veterans Health Administration |