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Takeaway: A training program and materials created by HSR&D investigators are helping to inform a comprehensive effort by VA's Office of Mental Health and Suicide Prevention to develop and roll-out a national training program on how best to discuss firearms storage safety with Veterans for primary care teams. Previous research found Veterans are open to discussing firearms storage safety in primary care setting if the topic is approached appropriately.
Promoting lethal means safety is one of the top priorities for VA’s Office of Mental Health and Suicide Prevention (OMHSP). Veterans are significantly more likely to use firearms as a means of suicide than the general population and reducing access to such lethal means is one of the few empirically supported approaches for lowering suicide rates. VA is working to move suicide prevention efforts “upstream” – to populations not necessarily viewed as high risk. As one upstream approach, primary care teams can encourage patients to take steps to improve household safety and reduce risk for suicide by putting distance between their firearms and themselves, particularly during times of emotional distress.
In the first part of a larger study to develop a training program on firearms storage safety (FSS) for VA primary care teams, investigators conducted focus groups and interviews with 68 Veterans to assess acceptance of FSS discussions during primary care visits. Investigators also conducted listening sessions and interviews with 107 primary care staff to identify facilitators and barriers to conducting FSS discussions and to identify strategies for primary care teams to effectively conduct these discussions with Veterans. Investigators conducted focus group sessions and/or individual interviews with study participants in 2018 and 2019. Results showed that there was general acceptance of having FSS discussions in primary care. Yet, most Veterans did not support direct questioning about firearm ownership, which may trigger fears of having firearms taken away or limiting their access to firearms.2 A few of the individual comments from Veterans included—
“If there’s going to be staff here that does that [discussion of firearms safety], they need to be the same person… If I’m going to open up to somebody, it’s gonna be somebody I trust. Not just somebody that says, ‘Doctor.’”2
“…if I ever did want to get a gun because of civil unrest, and I felt like I needed to protect myself, and I already on a ‘can’t get a gun list’ because I have PTSD?”2
From this work, investigators learned that primary care staff would like to have examples of how to effectively speak about FSS with Veterans. They then extracted sample messages regarding FSS by reviewing existing messaging on FSS that were publicly available online. A set of messages were presented to Veterans and clinicians during individual interviews to refine a set of sample scripts for staff to be able to use during visits. In addition to developing sample scripts for staff to use to guide firearms safety discussions, investigators identify learning objectives for the training program to guide program format.
After collaborating with VA's OMHSP and obtaining input from the National Shooting Sports Foundation, investigators created a pocket card for staff and a brochure for primary care patients. They also developed the interactive education session, “‘Just in Case’: Discussing Means Safety with Veterans at Elevated Risk for Suicide.” The program was designed to last 1.5 hours, include approximately 20–25 participants, and to be led by two facilitators: a mental health clinician, and a primary care provider. Investigators also recommend including a Veteran firearm owner to offer perspective regarding firearms ownership—and to answer questions that might regard on how firearms work.
Piloting the training program
Between April and July 2019, investigators piloted the training program in large VA primary care clinics. Participants (n=71) were asked to complete questionnaires just before – and immediately after each session. Questionnaires included items to assess experiences and attitudes related to firearms and to discussing firearms during primary care visits. The post-session questionnaire also asked about satisfaction with the educational program. Survey data obtained prior to the pilot training sessions showed low self-reported rates of discussing firearms safety with Veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS.
Implications
A training program and materials created by HSR&D investigators are currently helping to inform a comprehensive effort by VA’s OMHSP to develop and roll-out a national training program on how best to discuss firearms storage safety with Veterans for primary care teams over 2023 and 2024. Previous research found Veterans are open to discussing firearms storage safety in primary care setting if topic is approached appropriately.
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