Molly Davis1, Christina Johnson2, Amy R Pettit3, Shari Barkin4, Benjamin D Hoffman5, Shari Jager-Hyman2, Cheryl A King6, Adina Lieberman2, Lynn Massey7, Frederick P Rivara8, Eric Sigel9, Maureen Walton6, Courtney Benjamin Wolk10, Rinad S Beidas11. 1. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania (M Davis and RS Beidas), Philadelphia, Pa. Electronic address: molly.davis@pennmedicine.upenn.edu. 2. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa. 3. Independent Consultant (AR Pettit), Boston, Mass. 4. Department of Pediatrics, Vanderbilt University Medical Center (S Barkin), Nashville, Tenn. 5. Department of Pediatrics, School of Medicine, Doernbecher Children's Hospital, Oregon Health and Science University (BD Hoffman), Portland, Ore; Tom Sargent Children's Safety Center, Doernbecher Children's Hospital, Oregon Health and Science University (BD Hoffman), Portland, Ore. 6. Department of Psychiatry, Michigan Medicine, University of Michigan (CA King and M Walton), Ann Arbor, Mich. 7. Department of Emergency Medicine, Michigan Medicine, University of Michigan (L Massey), Ann Arbor, Mich. 8. Department of Pediatrics, University of Washington (FP Rivara), Seattle, Wash. 9. Department of Pediatrics, University of Colorado School of Medicine (E Sigel), Aurora, Colo. 10. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania (CB Wolk and RS Beidas), Philadelphia, Pa. 11. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (M Davis, C Johnson, S Jager-Hyman, A Lieberman, CB Wolk, and RS Beidas), Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania (M Davis and RS Beidas), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania (CB Wolk and RS Beidas), Philadelphia, Pa; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa; Department of Medicine, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania (RS Beidas), Philadelphia, Pa. Electronic address: rinad.beidas@pennmedicine.upenn.edu.
Abstract
OBJECTIVE: The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care. METHODS: We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo. RESULTS: Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm. CONCLUSIONS: Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.
OBJECTIVE: The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care. METHODS: We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo. RESULTS: Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm. CONCLUSIONS: Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.
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