Firearms have become the leading cause of death for children and teens in the United States, overtaking car crashes. Approximately 30 million children live in homes with guns, with nearly 5 million residing where firearms are loaded and unlocked. Concurrently, there has been a sharp increase in youth mental health struggles, heightening the risk of suicide and accidental shootings.
In response to this public health crisis and following the American Academy of Pediatrics’ recommendation for healthcare providers to engage families in gun safety discussions, researchers at the Center for Violence Prevention (CVP) at Children’s Hospital of Philadelphia (CHOP) launched a quality improvement initiative. This effort aimed to enhance firearm safety conversations within CHOP’s emergency departments in Philadelphia and King of Prussia. The findings, published in Academic Pediatrics, indicated success in delivering firearm safety resources to vulnerable families.
“By promoting safe firearm storage, medical professionals can contribute to broader efforts in reducing injury and mortality rates,” said Joel Fein, MD, MPH, senior author of the study and co-director of CVP at CHOP. “Our model serves as a valuable framework for other institutions seeking to implement similar prevention strategies.”
The study involved integrating standardized firearm safety questions into the electronic medical record system to ensure consistent inquiries about firearm access during behavioral health assessments. Additionally, emergency departments maintained an accessible supply of firearm safety resources like gun locks and educational handouts for distribution as needed.
Before this intervention, CHOP’s emergency departments lacked a standardized approach to documenting firearm safety among behavioral health patients and their families. Post-implementation saw screening documentation rates rise above 90% throughout the study period.
The availability and distribution of firearm safety resources improved significantly. Prior to the study, these resources were not offered to families seeking behavioral health support in emergency departments. By the end of the quality improvement process, 85% of patients who identified unsafely stored firearms at home received safety resources. The study authors include lead authors Katherine Donches, MD; Ashlee Murray, MD, MPH; Maggy Carka from Digital and Technology Services; and Mushyra Wright from Social Work.
Firearm safety device distribution is also occurring at several primary care practices and additional CHOP locations. As part of this program, cable lock safe storage devices are provided free through donations to CVP.
“As healthcare professionals, we experience firsthand the devastating impact of gun violence,” said Fein. “Just as we intervene to prevent disease, our findings show we can take steps to help put an end to unnecessary tragedies.”
Donches et al., “Improving Delivery of Firearm Safety Resources for Behavioral Health Patients in the Pediatric ED: A Quality Improvement Initiative.” Academic Pediatrics.Online April 22, 2025. DOI: 10.1016/j.acap.2025.102843.
