PROJECT SUMMARY 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. The research team has demonstrated success in the implementation and sustainability of alcohol screening, brief intervention and referral to treatment protocols in two federally funded multi-site trials at pediatric trauma centers. The team also has expertise in clinically-based strategies for firearm injury prevention and educational program development. We will apply our implementation science and subject matter expertise to implement a universal firearm injury prevention initiative within a national cohort of three pediatric trauma centers with which we have previously collaborated on multisite research. Our 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 proposal, submitted in response to RFA-CE-23-006 funding option B, 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), through the following primary aims: 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 treated within participating pediatric level 1 trauma centers, and through the following secondary aims: 1) increase trauma center clinicians’ firearm safety knowledge and confidence in delivering a firearm safety intervention; 2) increase firearm safety knowledge, attitudes and firearm safety practices of adolescent trauma patients (11-17 years) within participating pediatric level 1 trauma centers. Using the RE- AIM methodology, we will evaluate our comprehensive strategy across the domains of adoption, implementation, and maintenance at the institutional level. We will measure clinician firearm safety knowledge and confidence in delivering firearm prevention counseling after participation in the clinician training program as measured by pre and post training surveys. In addition, we will collect and analyze parent (n=560) and adolescent patient (n=280) data before and after ACTFAST implementation for changes in knowledge, attitudes and, most importantly, practices at baseline and at 2 weeks and 3 months after hospital discharge.

PROJECT NARRATIVE The proposed study will test the effectiveness of a comprehensive training strategy for the implementation of a universal pediatric-focused firearm injury prevention initiative. Findings will help to establish best practices for delivering firearm injury prevention screening and counseling within the pediatric trauma center. Importantly, this research has the potential to impact clinical care, prevent firearm-related injury and death, and significantly contribute to implementation science.