Health Systems Interventions to Prevent Firearm Injuries and Death Proceedings of a Workshop (2019) / Chapter Skim
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4 Identifying Individuals at Higher Risk for Firearm Violence
4 Identifying Individuals at Higher Risk for Firearm Violence
Pages 27-36
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From page 27... ...
Bair-Merritt, the executive director of the Center for the Urban Child and Healthy Family, an associate professor of pediatrics and the associate division chief of general pediatrics at Boston Medical Center; Christopher Barsotti, the chief executive officer of the American Foundation for Firearm Injury Reduction in Medicine ( FFIRM) and the chair of the Trauma and Injury Prevention Section A of the American College of Emergency Physicians; and David C
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From page 28... ...
Other important risk factors include women's assessment of their own risk and worries about escalating violence and a prior history of choking and strangulation. "This is predictive of future death and morbidity," Bair-Merritt said, "and so this is something we have to really listen and pay attention to." She also commented that most of the literature on identifying survivors of domestic violence who may be at risk comes from the Danger Assessment instrument developed by Jacquelyn Campbell at Johns Hopkins University (Campbell et al., 2009; Messing et al., 2017; Snider et al., 2009)
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From page 29... ...
" In her opinion, she said, speaking as a pediatrician, she believes that health care needs to think more about what its response should be when children are in homes with IPV, given the future risk for violence those children may face as a result of IPV exposure. APPLYING A MEDICAL MODEL OF DISEASE TO IDENTIFY THOSE AT RISK OF FIREARM VIOLENCE Barsotti said that his interest in identifying those at risk of firearm violence arose from his experience working at a rural level 3 trauma center, where he and his partners had intervened in cases where they thought there was a chance of mass violence, suicide, or IPV.
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From page 30... ...
To the extent that we can improve the accuracy and the discrimination of those tools, we will be much better off." He acknowledged that, given the current funding environment, developing such tools for predicting risk of firearm violence will be difficult, but he said that he believes there is ongoing research on mental health services that could be extended to develop multivariate modeling for predicting who is at risk for a firearm injury.
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From page 31... ...
Richmond asked Bair-Merritt if health care systems and providers attend equally to identifying potential victims and potential perpetrators of firearm violence, to which she said no. "If you look at all of the work on intimate partner violence screening, there is much more for survivors of violence than there is for perpetrators of violence," Bair-Merritt said.
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From page 32... ...
With regard to what health systems need to put in place for providers to recognize the need and then screen for those at higher risk, Grossman said a good place to start would be for health systems to develop clinical guidelines that are based on evidence, continually revised when new evidence becomes available, and tailored to the site of care, such as the emergency department or the primary care office. Then these procedures will need to be embedded in the workflow in a way that fits the clinician's practice.
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From page 33... ...
Bair-Merritt said that she is concerned that asking about domestic violence will become a checklist item rather than a true conversation. On the other hand, Gregory Simon from Kaiser Permanente Washington State said that simple multiple choice, yes/no questions administered on clipboards or in waiting room kiosks by medical assistants with not much more than high school training are quite accurate at identifying people who are at high risk for self-directed violence or death by suicide.
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From page 34... ...
When asked to identify important research questions to address that would enable health systems to accurately identify higher-risk individuals, Grossman said it would be important and helpful to develop multivariate models, particularly around the interaction of alcohol and mental health, in order to better understand who is at higher risk for gun violence and to identify the key variables driving gun violence. "We have become good at predicting univariate risk, but not so great on multivariate risk," he said.
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From page 35... ...
Washington State's new Accountable Communities of Health process, which is empowering and funding clusters of counties to be accountable for their own epidemiology and planned interventions for their own regions, is a promising approach to community-focused interventions, he said. Barsotti said that many victims of gun violence belong to a network of other highrisk individuals, and social media may provide an opportunity to identify those network members.
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From page 36... ...
For example, he said, he and his colleagues conducted a randomized trial of gun safes in rural Alaska among the Alaska native population, and they spent time with that population trying to understand its behavior around guns as well as to understand what is socially acceptable around storage practice. "We tried to map that out ethnographically before we even began to think about implementing the trial," he said.
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