A Professor’s Passion for Preventing Pediatric Firearm Injuries and Deaths

Not long after having her first child, Rinad Beidas sat in the pediatrician’s office for a well-child visit and answered questions about safety, from her child’s sleeping environment to fire alarms in the house to car seats.

When Beidas left the office, however, she realized something: the pediatrician never asked if there was a gun in the house and, if so, how adults stored the firearm. Having recently lost a family member to suicide with a firearm, Beidas describes this as a “lightbulb moment.”

“Why wasn’t having a firearm in the house an important safety matter worth discussion?” she wondered.

Beidas, the Ralph Seal Paffenbarger Professor of Medical Social Sciences at Northwestern University’s Feinberg School of Medicine, dug into existing scientific literature. She uncovered an evidence-based program tested in a large national trial for supporting secure firearm storage in the pediatric primary care environment. Despite the American Academy of Pediatrics, the nation’s largest professional association of pediatricians and an influential force in the medical community, recommending pediatric clinicians engage parents on the topic of secure firearm storage, few pediatricians incorporated the practice into their daily routines.

Beidas saw promoting secure gun storage as a way to counter fatalities by firearm injury, the leading cause of death for young people in the U.S. One in three American homes has a firearm and, in many cases, firearms are not stored in such a way preventing unauthorized access.

To reverse these troubling realities, Beidas harnessed the tools of implementation science. The burgeoning, transdisciplinary field brings scientific research and evidence-based practices – many initially supported by federal funding and now languishing in the scientific abyss – into real-world settings to benefit the public.

A promising intervention

Beidas and her team began their efforts by speaking with parents, clinicians, payers, firearms rights advocates, and other key stakeholders to understand what it might take to implement a secure firearm safety program in pediatric primary care as a universal suicide prevention strategy. Those conversations fueled adaptations to the existing evidence-based practice and sparked the creation of the S.A.F.E. Firearm program.

A scalable, low-cost program, S.A.F.E. Firearm includes a brief – “Less than a minute,” Beidas says. – conversation between a pediatric clinician and a parent as well as an offer of a free cable lock.

“Firearm injury and suicide by firearm has been increasing for young people in the United States, so the pediatrician’s office feels like a really important place to bring implementation science methods and deploy a program that can save lives,” Beidas says, adding that a 2019 study published by JAMA Pediatrics suggested even a modest increase in secure firearm storage could prevent up to 32 percent of youth firearm deaths.

The idea in hand, Beidas’ group, in partnership with colleagues from Kaiser Permanente Colorado and Henry Ford Health, then tested the implementation of S.A.F.E. Firearm in a large trial across 30 pediatric primary care clinics in Colorado and Michigan covering nearly 400 clinicians and 50,000 well-child visits. In half of the clinics, Beidas’ team provided pediatricians with a reminder on the electronic health records’ (EHR) visit documentation template to have the firearm safety conversation and offer the cable lock. With the other half, the researchers offered the EHR reminder in addition to consultation on how clinicians could embed the innovation into the appointment, a process known as facilitation.

Before the trial, Beidas says “at most” 2 percent of clinicians carried out both components of the evidence-based program. After, however, full program participation rose to 22 percent in the clinics that received the EHR reminder and 49 percent in those given the reminder alongside facilitation.

“That’s a pretty robust behavior change to me,” Beidas says. “This is an implementation success story.”

Pushing for wider implementation

Over recent years, Beidas and her team have extended their work. With the help of funding from the National Institutes of Health, including the National Institute of Nursing Research and the National Institute of Mental Health, they are testing how best to scale the program to federally qualified health centers in Illinois as well as women’s health and adult primary care centers at Kaiser Permanente Colorado and Henry Ford. Other health systems have reached out and inquired about implementing the program in their environments. Beidas, meanwhile, continues pursuing funding to support an even larger-scale study to demonstrate the program’s effectiveness on pediatric firearm injury and mortality outcomes.

“We have a program that’s ready to be deployed nationally and can save young lives,” says Beidas, a member of Northwestern’s newly established Institute for Adolescent Mental Health and Well-Being.

While the community-engaged approach of Beidas’ team has certainly contributed to the S.A.F.E. Firearm program’s early success, so, too, has the moment. More than ever, Beidas says, clinicians recognize unauthorized firearm access as a significant issue to children’s health and want to eliminate the tragedies of adolescent suicides and mass shootings by young adults.

“We focus on secure firearm storage because it’s a nonpartisan, agreed-upon way to restrict unauthorized access to firearms,” Beidas says. “Our work is very much respectful of the fact that Americans have the right to bear arms and also centered around our shared mission to keep young people safe, which everybody can get behind.”