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Adapting Safety Check as a Universal Suicide Prevention Strategy in Pediatric Primary Care

  • Author Footnotes
    ⁎ The asterisk denotes that Molly Davis and Christina Johnson are co-first authors.
    Molly Davis
    Correspondence
    Address correspondence to Rinad S. Beidas, PhD or Molly Davis, PhD, Penn Center for Mental Health, 3535 Market St, Philadelphia, PA 19104
    Footnotes
    ⁎ The asterisk denotes that Molly Davis and Christina Johnson are co-first authors.
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa

    Penn Implementation Science Center at the Leonard Davis Institute of Health Economics ([email protected]), University of Pennsylvania (M Davis and RS Beidas), Philadelphia, Pa
    Search for articles by this author
  • Author Footnotes
    ⁎ The asterisk denotes that Molly Davis and Christina Johnson are co-first authors.
    Christina Johnson
    Footnotes
    ⁎ The asterisk denotes that Molly Davis and Christina Johnson are co-first authors.
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa
    Search for articles by this author
  • Amy R. Pettit
    Affiliations
    Independent Consultant (AR Pettit), Boston, Mass
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  • Shari Barkin
    Affiliations
    Department of Pediatrics, Vanderbilt University Medical Center (S Barkin), Nashville, Tenn
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  • Benjamin D. Hoffman
    Affiliations
    Department of Pediatrics, School of Medicine, Doernbecher Children's Hospital, Oregon Health and Science University (BD Hoffman), Portland, Ore

    Tom Sargent Children's Safety Center, Doernbecher Children's Hospital, Oregon Health and Science University (BD Hoffman), Portland, Ore
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  • Shari Jager-Hyman
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa
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  • Cheryl A. King
    Affiliations
    Department of Psychiatry, Michigan Medicine, University of Michigan (CA King and M Walton), Ann Arbor, Mich
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  • Adina Lieberman
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa
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  • Lynn Massey
    Affiliations
    Department of Emergency Medicine, Michigan Medicine, University of Michigan (L Massey), Ann Arbor, Mich
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  • Frederick P. Rivara
    Affiliations
    Department of Pediatrics, University of Washington (FP Rivara), Seattle, Wash
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  • Eric Sigel
    Affiliations
    Department of Pediatrics, University of Colorado School of Medicine (E Sigel), Aurora, Colo
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  • Maureen Walton
    Affiliations
    Department of Psychiatry, Michigan Medicine, University of Michigan (CA King and M Walton), Ann Arbor, Mich
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  • Courtney Benjamin Wolk
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa

    Leonard Davis Institute of Health Economics, University of Pennsylvania (CB Wolk and RS Beidas), Philadelphia, Pa
    Search for articles by this author
  • Rinad S. Beidas
    Correspondence
    Address correspondence to Rinad S. Beidas, PhD or Molly Davis, PhD, Penn Center for Mental Health, 3535 Market St, Philadelphia, PA 19104
    Affiliations
    Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa

    Penn Implementation Science Center at the Leonard Davis Institute of Health Economics ([email protected]), University of Pennsylvania (M Davis and RS Beidas), Philadelphia, Pa

    Leonard Davis Institute of Health Economics, University of Pennsylvania (CB Wolk and RS Beidas), Philadelphia, Pa

    Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa

    Department of Medicine, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa

    Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa
    Search for articles by this author
  • Author Footnotes
    ⁎ The asterisk denotes that Molly Davis and Christina Johnson are co-first authors.
Published:April 23, 2021DOI:https://doi.org/10.1016/j.acap.2021.04.012

      Abstract

      Objective

      The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care.

      Methods

      We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo.

      Results

      Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm.

      Conclusions

      Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.

      Keywords

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      References

        • Cunningham RM
        • Walton MA
        • Carter PM
        The major causes of death in children and adolescents in the United States.
        N Engl J Med. 2018; 379: 2468-2475https://doi.org/10.1056/NEJMsr1804754
        • Grossman DC
        • Mueller BA
        • Riedy C
        • et al.
        Gun storage practices and risk of youth suicide and unintentional firearm injuries.
        JAMA. 2005; 293: 707-714https://doi.org/10.1001/jama.293.6.707
        • Kposowa A
        • Hamilton D
        • Wang K
        Impact of firearm availability and gun regulation on state suicide rates.
        Suicide Life Threat Behav. 2016; 46: 678-696https://doi.org/10.1111/sltb.12243
        • Dowd MD
        • Sege RD
        Council on Injury Violence and Poison Prevention Executive Committee. Firearm-related injuries affecting the pediatric population.
        Pediatrics. 2012; 130: e1416-e1423https://doi.org/10.1542/peds.2012-2481
      1. The Society for Adolescent Health and Medicine. Preventing firearm violence in youth through evidence-informed strategies.
        J Adolesc Health. 2020; 66: 260-264https://doi.org/10.1016/j.jadohealth.2019.11.295
        • Barkin SL
        • Finch SA
        • Ip EH
        • et al.
        Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial.
        Pediatrics. 2008; 122: e15-e25https://doi.org/10.1542/peds.2007-2611
        • Beidas RS
        • Jager-Hyman S
        • Becker-Haimes E
        • et al.
        Acceptability and use of evidence-based practices for firearm storage in pediatric primary care.
        Acad Pediatr. 2019; 19: 670-676https://doi.org/10.1016/j.acap.2018.11.007
        • Wingood GM
        • DiClemente RJ
        The ADAPT-ITT model: a novel method of adapting evidence-based HIV interventions.
        J Acquir Immune Defic Syndr. 2008; 47: S40-S46https://doi.org/10.1097/QAI.0b013e3181605df1
        • Miller M
        • Azrael D
        • Barber C
        Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide.
        Annu Rev Public Health. 2012; 33: 393-408https://doi.org/10.1146/annurev-publhealth-031811-124636
        • Azrael D
        • Cohen J
        • Salhi C
        • et al.
        Firearm storage in gun-owning households with children: results of a 2015 national survey.
        J Urban Health. 2018; 95: 295-304https://doi.org/10.1007/s11524-018-0261-7
        • Monuteaux MC
        • Azrael D
        • Miller M
        Association of increased safe household firearm storage with firearm suicide and unintentional death among US youths.
        JAMA Pediatr. 2019; 173: 657-662https://doi.org/10.1001/jamapediatrics.2019.1078
      2. Collins K, Yaffe-Bellany D. About 2 million guns were sold in the US as virus fears spread. The New York Times. 2020. Available at: https://www.nytimes.com/interactive/2020/04/01/business/coronavirus-gun-sales.html. Accessed August 28, 2020.

      3. Uddin SG, O'Connor KS, Ashman JJ. Physician office visits by children for well and problem-focused care: United States, 2012. 2016. Available at: https://www.cdc.gov/nchs/data/databriefs/db248.pdf. Accessed August 28, 2020.

        • Garbutt JM
        • Bobenhouse N
        • Dodd S
        • et al.
        What are parents willing to discuss with their pediatrician about firearm safety? A parental survey.
        J Pediatr. 2016; 179: 166-171https://doi.org/10.1016/j.jpeds.2016.08.019
        • DeMello AS
        • Rosenfeld EH
        • Whitaker B
        • et al.
        Keeping children safe at home: parent perspectives to firearms safety education delivered by pediatric providers.
        South Med J. 2020; 113: 219-223https://doi.org/10.14423/SMJ.0000000000001096
        • Wolk CB
        • Van Pelt AE
        • Jager-Hyman S
        • et al.
        Stakeholder perspectives on implementing a firearm safety intervention in pediatric primary care as a universal suicide prevention strategy: a qualitative study.
        JAMA Network Open. 2018; 1: e185309https://doi.org/10.1001/jamanetworkopen.2018.5309
        • Roszko PJ
        • Ameli J
        • Carter PM
        • et al.
        Clinician attitudes, screening practices, and interventions to reduce firearm-related injury.
        Epidemiol Rev. 2016; 38: 87-110https://doi.org/10.1093/epirev/mxv005
        • Colby SM
        • Monti PM
        • Tevyaw TO
        • et al.
        Brief motivational intervention for adolescent smokers in medical settings.
        Addict Behav. 2005; 30: 865-874https://doi.org/10.1016/j.addbeh.2004.10.001
        • Aarons GA
        • Sklar M
        • Mustanski B
        • et al.
        “Scaling-out” evidence-based interventions to new populations or new health care delivery systems.
        Implement Sci. 2017; 12https://doi.org/10.1186/s13012-017-0640-6
        • Stirman SW
        • Baumann AA
        • Miller CJ
        The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions.
        Implement Sci. 2019; 14https://doi.org/10.1186/s13012-019-0898-y
        • Carney T
        • Chimbambo V
        • Johnson K
        • et al.
        The adaptation of an evidence-based brief intervention for substance-using adolescents and their caregivers.
        Psychother Res. 2020; 30: 728-738https://doi.org/10.1080/10503307.2019.1656352
        • Jager-Hyman S
        • Wolk CB
        • Ahmedani BK
        • et al.
        Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study.
        J Behav Med. 2019; 42: 691-701https://doi.org/10.1007/s10865-019-00074-9
        • Tong A
        • Sainsbury P
        • Craig J
        Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.
        Int J Qual Health Care. 2007; 19: 349-357https://doi.org/10.1093/intqhc/mzm042
        • Guest G
        • Bunce A
        • Johnson L
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82https://doi.org/10.1177/1525822X05279903
        • Guest G
        • Namey E
        • Chen M
        A simple method to assess and report thematic saturation in qualitative research.
        PLoS One. 2020; 15e0232076https://doi.org/10.1371/journal.pone.0232076
        • Bradley EH
        • Curry LA
        • Devers KJ
        Qualitative data analysis for health services research: developing taxonomy, themes, and theory.
        Health Serv Res. 2007; 42: 1758-1772https://doi.org/10.1111/j.1475-6773.2006.00684.x
        • Charmaz K
        Grounded theory: objectivist and constructivist methods.
        in: Denzin NK Lincoln YS Handbook of Qualitative Research. 2nd ed. Sage, Thousand Oaks, CA2000: 509-535
        • Rothman EF
        • Paruk J
        • Espensen A
        • et al.
        A qualitative study of what US parents say and do when their young children see pornography.
        Acad Pediatr. 2017; 17: 844-849https://doi.org/10.1016/j.acap.2017.04.014
        • Weiner BJ
        • Lewis CC
        • Stanick C
        • et al.
        Psychometric assessment of three newly developed implementation outcome measures.
        Implement Sci. 2017; 12https://doi.org/10.1186/s13012-017-0635-3
        • Finn A
        • Louviere JJ
        Determining the appropriate response to evidence of public concern: the case of food safety.
        J Public Policy Market. 1992; 11: 12-25https://doi.org/10.1177/074391569201100202
        • Beidas R
        • Rivara F
        • Rowhani-Rahbar A
        Safe firearm storage: a call for research informed by firearm stakeholders.
        Pediatrics. 2020; 146e20200716https://doi.org/10.1542/peds.2020-0716
        • Hinnant A
        • Boman CD
        • Hu S
        • et al.
        The third rail of pediatric communication: discussing firearm risk and safety in well-child exams.
        Health Commun. 2019; https://doi.org/10.1080/10410236.2019.1700883
        • Hoskins K
        • Paladhi UR
        • McDonald C
        • et al.
        Applying behavioral economics to enhance safe firearm storage.
        Pediatrics. 2020; 145e20192268https://doi.org/10.1542/peds.2019-2268
        • Becker SJ
        Direct-to-consumer marketing: a complementary approach to traditional dissemination and implementation efforts for mental health and substance abuse interventions.
        Clin Psychol Sci Pract. 2015; 22: 85-100https://doi.org/10.1111/cpsp.12086
        • Smith J
        • Rapport F
        • O'Brien TA
        • et al.
        The rise of rapid implementation: a worked example of solving an existing problem with a new method by combining concept analysis with a systematic integrative review.
        BMC Health Serv Res. 2020; 20https://doi.org/10.1186/s12913-020-05289-0