Presenter Profile
Emma Cornell, MPH
Northwell Health Center for Gun Violence Prevention
Emma Cornell is the Clinical Research Program Manager for the Center for Gun Violence Prevention at Northwell Health. She holds an MPH degree from Columbia’s Mailman School of Public Health, where she pursued a specialized course of study in injury and violence prevention focusing on firearm injury prevention. Her work at the Center aims to help further the evidence base for firearm injury prevention strategies at all levels of the health system. Prior to joining the Northwell team, she was involved in several community-level interventions addressing both physical and social determinants of health, serving as a volunteer EMT, and working to improve educational access through a prison education program. Her previous research focused on addressing the psychosocial impact of trauma among survivors of campus sexual assault, and caregiver perspectives on firearm safety counseling for youth experiencing acute mental health crises. She has worked with numerous academic and advocacy organizations to study a variety of topics ranging from medication assisted treatment for opioid use disorder, to the utilization of firearm surrender laws in situations of domestic violence.
Presentations
Universal Screening for Pediatric Firearm Injury Risk: Preliminary Results from the Firearm Injury and Mortality Prevention (FIMP) Initiative
Emma Cornell, MPH
Laura Harrison, MPH
Monica Shekher-Kapoor, MD
Sandeep Kapoor, MD, MS-HPPL
Chethan Sathya, MD, MSc, FRCSC, FACS
Firearms are the leading cause of death for US children and adolescents. Emergency departments (EDs) present unique opportunities to adopt Firearm Injury and Mortality Prevention (FIMP) strategies, serving as safety nets during times of crisis, providing care for those without primary healthcare sources, and treating patients with firearm-related injuries. Pediatric healthcare providers routinely screen for a variety of health concerns, providing anticipatory guidance and educational resources to patients and caregivers to promote health and safety. Thus, pediatric EDs provide optimal environments for implementation of FIMP strategies as part of usual care. We implemented a universal FIMP screening program to normalize conversations about firearm safety and violence risk for all patients, caregivers, and healthcare team members. This universal screening strategy was based on successful implementation of a “We Ask Everyone” approach using Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use. We applied this SBIRT framework for substance use to FIMP, based on synergistic goals and harm reduction principles, to maximize reach to all patients and destigmatize firearm injury risk.
Universal screening for firearm access and violence risk for patients > 12 years was implemented in three New York hospitals, including one pediatric ED beginning in July 2021. For adolescent patients ages 12-17, screening consists of a question about firearm access within or outside the household, and the 4-question SaFETy score, a validated tool to predict future firearm violence risk. Screening tools and reports were programmed into the electronic health record (EHR). Prior to implementation, asynchronous online education for healthcare team members was disseminated exploring FIMP as a public health issue, reviewing the screening tool, workflow, documentation, and available resources. Additional synchronous education was provided to team members providing support to patients who screened positive.
Since implementation through April 2023, 4,649 pediatric patients ages 12-17 across the three EDs were screened for firearm injury and violence risk. Among patients at our pediatric ED, 16.13% of all patients (4,503 total) were screened. 79 (1.75%) screened positive for firearm access, and 134 (2.98%) screened positive for violence risk, with 217 (4.67%) positive screens overall. Among pediatric patients with a positive screen, 77 (19.35%) were approached for a full screen, brief intervention (using motivational interviewing and the brief negotiated interview) and resources.
Pediatric ED FIMP screening is a promising tool to identify, and subsequently provide patients and families with resources and support to increase safety and reduce risk associated with firearm access and violence risk. Factors associated with increased FIMP utilization include robust championship by ED leadership and ongoing, health system-wide prioritization of firearm injuries as a public health concern. Disruptions to clinical workflows including COVID-19 and subsequent RSV and influenza surges temporarily reduced pediatric FIMP screens, which improved over time. Future steps include expansion of FIMP screening to additional pediatric service lines system-wide.
1. Attendees will be able to describe the utility of universal screening for firearm injury risk in the pediatric emergency department setting
2. Attendees will be able to identify opportunities to integrate conversations around firearm safety and violence prevention within standard clinical interactions
3. Attendees will be able to determine barriers and facilitators to ED adoption of firearm injury prevention strategies