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Principal Investigator: Rinad Sary Beidas
Organization: NORTHWESTERN UNIVERSITY AT CHICAGO
Fiscal Year: 2024
Award: $764,545
Funding agency: National Institute of Nursing Research
Firearms are now the leading cause of death for young people in the United States, with stark inequities for
young people from minoritized communities (e.g., race, ethnicity, LGTBQ+ populations). Secure firearm storage
programs are evidence-based, low-cost, scalable, and non-politically divisive. Current efforts to implement these
programs primarily occur in ambulatory and acute care settings in largely well-resourced health systems. There
is a need to study adaptation and implementation of these programs in community settings including federally
qualified health centers (FQHCs) and look-alike safety net health centers. These community settings currently
serve 1 in 11 people seeking health care in the United States and prioritize offering services to all areas and
populations, thus making them critical partners for efforts to promote equitable delivery to all populations. In
2023, our team completed the largest hybrid effectiveness-implementation type III trial of its kind (R01
MH123491; “ASPIRE”), in which ~45,000 pediatric well-visits in 30 clinics in two large health systems were
eligible to receive S.A.F.E. Firearm, an evidence-based, universal secure firearm storage program that includes
a brief conversation between a clinician and parent about secure firearm storage and offering free cable locks.
Prior to implementation, clinicians delivered these program components in 3% of well-visits. After clinics and
clinicians received training, clinical decision support in the electronic health record, and facilitation, clinicians
delivered these program components in 41% of well-visits, representing robust practice change that can save
lives. In the proposed study, “COMMUNITY-ASPIRE,” we partner with AllianceChicago, a national practice-
based research network, and the Illinois Primary Health Care Association, the state-wide organization for
FQHCs, to study the adaptation and implementation of S.A.F.E. Firearm in Illinois FQHCs. In Aim 1, in
collaboration with key partners (e.g., clinicians, leaders, parents), we will adapt and optimize S.A.F.E. Firearm
and our implementation approach for FQHCs. In Aim 2, we will conduct a pragmatic hybrid type III stepped
wedge effectiveness-implementation randomized controlled trial with 12 FQHCs and 720 participants across
Illinois to test the effectiveness of our adapted implementation approach (training and facilitation emphasizing
equitable S.A.F.E. Firearm delivery) on parent-reported receipt of S.A.F.E. Firearm (i.e., reach; primary
implementation outcome). We will also assess secondary implementation outcomes (stage of implementation,
cost, acceptability) and effectiveness outcomes (parent firearm storage behavior). In Aim 3, we will use mixed
methods to identify mechanisms. First, we will conduct interviews to understand constituent perspectives on
implementation mechanisms and equitable intervention receipt. Second, we will evaluate reach and firearm
storage behavior by demographic characteristics and social determinants of health. Results will guide future
implementation of secure firearm storage programs in FQHCs and prioritize scalability, generalizability, and
equity. Successful strategies can be taken to scale to save lives, in keeping with the NINR strategic plan.
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