Pediatric Trauma Centers RE-AIM at Gun Safety

Study Overview
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Brief Summary
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Universal firearm injury and violence prevention counseling of parents and patients has been recommended by multiple national organizations for over a decade, yet clinicians rarely deliver this counseling. Barriers to its implementation must be addressed in order to effectively deliver firearm related injury prevention efforts. This study will implement a universal firearm injury prevention initiative within a national cohort of three pediatric trauma centers. The investigator's long-term goal is to demonstrate best practices for pediatric trauma center-based firearm injury prevention strategies that promote safe storage practices and reduce firearm related injury and death. This research will test the effectiveness of a comprehensive training strategy for improving the implementation of a universal firearm injury prevention effort, ACTFAST (Adopting Comprehensive Training for FireArm Safety in Trauma centers), to 1) increase the adoption, implementation and sustainability of a universal firearm injury prevention initiative within participating pediatric level 1 trauma centers; 2) increase firearm safety knowledge, attitudes and safe firearm storage practices among parents of pediatric trauma patients and youth patients treated within participating pediatric level 1 trauma centers, and 3) increase trauma center clinicians' firearm safety knowledge and confidence in delivering a firearm safety intervention.

Official Title
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Pediatric Trauma Centers RE-AIM at Gun Safety - Adopting Comprehensive Training for FireArm Safety in Trauma Centers

Conditions
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Firearm Injury, Safety Issues

Intervention / Treatment
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* Behavioral: Adopting Comprehensive Training for FireArm Safety in Trauma centers


Participation Criteria
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Eligibility Criteria
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For parents/guardians of pediatric trauma patients: Inclusion Criteria: live with an admitted pediatric trauma patient at a participating trauma center be fluent in English or Spanish Exclusion Criteria: - family members who do not live with the admitted pediatric trauma patient For youth trauma patients: Inclusion Criteria: Must be between the ages of 11-17 years admitted to a participating trauma inpatient service for an injury fluent in English or Spanish able to provide written assent and parent able to provide written consent Exclusion Criteria: Youth who are prisoners or in police custody Youth who are admitted due to suicide attempt Youth with acute conditions that would preclude provision of informed consent (i.e., acute psychosis, altered mental status, cognitive impairment)

Ages Eligible for Study
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Minimum Age: 11 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard Care<br>In the pre-implementation period, all trauma patients will receive standard routine care. Which may include some screening and counseling on gun safety. | |
| Experimental: ACTFAST Intervention<br>During the implementation and maintenance periods, all trauma patients will receive study activities including firearm access screening, counseling on safe storage practices, and referral to safe storage and other community resources as appropriate. | Behavioral: Adopting Comprehensive Training for FireArm Safety in Trauma centers<br>* Firearm access screening, brief firearm safe storage intervention, and referral to community and preventive health resources<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Implementation of Intervention | This outcome will be measured using chart review protocols examining rates of firearm access screening, documentation of firearm safety counseling, documentation of referral to community based resources and connection to medical homes as well as patient hospitalization characteristics including admission diagnosis, injury severity and patient demographic characteristics. | 3 years | 
| Parent firearm safety attitudes and behaviors | This outcome will be measured using parent survey and interview adapted from prior work by the study team. | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinician firearm safety knowledge and confidence | This outcome will be measured using clinician surveys derived from multiple sources developed through the prior work of members of the study team. | 3 years | 
| Adolescent patient firearm safety attitudes and behaviors | Measure firearm injury prevention knowledge, attitudes and safe firearm practices of adolescent trauma patients (11-17 years) within participating pediatric level 1 trauma centers. This outcome will be measured using patient survey and interview adapted from prior work by the study team. | 3 years |