Population Health Institute
Translating Research for Policy and Practice

Firearm Screening Question

Note: This strategy is for anyone working in crisis support and is not limited to those with a formal counseling or therapy title.

 

Strategy Description

Staff trained in crisis support should ask a standard screening question regarding firearm access, bundled with formal or informal screening or assessment questions, or at a different point in the conversation.  Evidence shows that routine use of a nonjudgmental standard firearm screening question normalizes and encourages dialogue about firearm access. If it’s asked at a different point in the conversation, there should first be a normalizing statement. Follow-up questions may be asked after the standard screening question.

Action Steps Based on the Literature 

  1. Develop a structured firearm access screening question: Use structured questions for evaluating the risk of violence, as they are more accurate and reliable than unstructured clinical judgment1. A standard, nonjudgmental firearm access question that is built into a protocol generally receives a positive response from staff asking the question and people being asked the question2. One study had positive findings related to the screening question “Do you have access to guns?”2.
  2. Determine when the standard screening question will be asked in the conversation: Consider including the firearm access screening question in the initial set of health and safety screening questions asked at the beginning of the conversation3,4. If the question is not bundled with the standard screening and is instead asked later in the conversation, begin with a normalizing statement before asking the question regarding firearm access4, 5. Normalizing statement examples may include: “Many people I talk to have firearms in or around their home for hunting, target shooting, or home defense. Do you have access to guns?2,4″
  3. Determine which helpseekers will be asked the question: Depending on workflow and capacity, it may be beneficial to ask the screening question regardless of screening positive or not for suicidal or homicidal thoughts, or it may make more sense to ask the screening question only to those with elevated risk of suicide, including children and youth, people experiencing intimate partner violence, those living in community violence, or those who are elderly3,4.  Repeated firearm access assessments and discussions are important over time4, so it may be beneficial to screen helpseekers even if they have contacted the crisis line or service before.
  4. Train crisis support staff on the firearm access screening protocol: Address barriers such as time pressure, lack of firearm knowledge, and fear of politics being brought up6,7,8. Staff should be comfortable in asking the screening question in a nonjudgmental way and discussing firearm access as part of holistic care, including communicating the purpose of the question and how responses will be used and protected2. To prepare for further conversation beyond the screening question, ensure staff are trained in (1) cultural humility and trauma-informed practices, (2) lethal means counseling with secure storage information, and (3) safety planning and follow-up.
  5. Always de-escalate the situation for helpseekers when possible: Staff trained in crisis support should remain aware of their own reactions or biases to ensure proper assessment of imminent risk9 and use emergency services only when less invasive intervention, such as lethal means counseling and safety planning, have been unsuccessful.

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Evidence Summary

Unstructured clinical judgement for risk of violence is less accurate and less reliable than structured assessment questions1. When nonjudgmental, standard firearm access questions are implemented, there is generally a positive response among all parties2. While some studies suggest that everyone should be screened for firearm access, especially when people may be at in increased risk of suicide or homicide by firearm7, the same study emphasized that if this isn’t feasible, prioritize those at suicide or homicide risk; this includes those who screen positive for thinking about suicide and/or homicide, and those in populations that are at higher risk for suicide or homicide by firearm4. People who have elevated risks with injury or death due to firearms include children and youth, people experiencing intimate partner violence, people exposed to community violence, people who are depressed or suicidal, and older adults3. The question should be straightforward and nonjudgemental2. In one study, some participants suggested that screening for firearms would be acceptable if bundled with other questions5.  Additionally, repeated assessments and discussions over time are important4.

In one study, patients described how to destigmatize firearm access by emphasizing nonjudgement, approaching from a public health perspective, and discussing firearm access as a holistic part of care2. They also described the importance of transparency, autonomy, and context, including understanding the purpose of the firearm access question2. Clinicians suggested discussing how patients’ responses will be used and protected2. There is a need to communicate that the intended purpose of routine questions about firearm access is to support conversations about suicide prevention, not to limit patient autonomy2. In this study, the screening question was “Do you have access to guns?”

The screening question can be included in the integration of the initial screening questions about health and safety4,5. If the question is not bundled with other screening questions, the questions should begin with a normalizing statement and then proceed with the screening question4. Adapted from Carter and Cunningham4, examples of normalizing statements include: “I talk with everyone about home safety,” and “Many people I talk to have firearms in or around their home for hunting, target shooting, or home defense.”

Barriers to asking firearm screening questions include time pressure and lack of knowledge7. Most people are willing to discuss firearm safety in the context of their healthcare and safety6,11. Some staff report feeling uncomfortable with asking firearm screening questions as they may be unfamiliar with firearm terminology and culture or worry about the discussion devolving into politics8.

References

  1. Ahonen, L., Loeber, R., & Brent, D. A. (2017). The association between serious mental health problems and violence: Some common assumptions and misconceptions. Trauma, Violence, & Abuse, 20(5), 613–625. https://doi.org/10.1177/1524838017726423
  2. Richards, J. E., Kuo, E. S., Whiteside, U., Shulman, L., Betz, M. E., Parrish, R., Boggs, J. M., Rowhani-Rahbar, A., & Simon, G. E. (2022). Patient and clinician perspectives of a standardized question about firearm access to support suicide prevention: A qualitative study. JAMA Health Forum, 3(11), e224252. https://doi.org/10.1001/jamahealthforum.2022.4252
  3. Rapp-McCall, L., & Lucio, R. (2024). Firearm access and safe storage. Advances in Social Work, 24(1), 48–65. https://doi.org/10.18060/27395
  4. Carter, P. M., & Cunningham, R. M. (2024). Clinical approaches to the prevention of firearm-related injury. The New England Journal of Medicine, 391(10), 926–940. https://doi.org/10.1056/NEJMra2306867
  5. Jager-Hyman, S., Benjamin Wolk, C., Ahmedani, B. K., Zeber, J. E., Fein, J. A., Brown, G. K., Byeon, Y. V., Listerud, H., Gregor, C. A., Lieberman, A., & Beidas, R. S. (2019). Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: A qualitative study. Journal of Behavioral Medicine, 42(4), 691–701. https://doi.org/10.1007/s10865-019-00074-9
  6. Betz, M. E., Azrael, D., Barber, C., & Miller, M. (2016). Public opinion regarding whether speaking with patients about firearms is appropriate: Results of a national survey. Annals of Internal Medicine, 165(8), 543–550. https://doi.org/10.7326/M16-0739
  7. Pallin, R., Spitzer, S. A., Ranney, M. L., Betz, M. E., & Wintemute, G. J. (2019). Preventing firearm-related death and injury. Annals of Internal Medicine, 170(11). https://doi.org/10.7326/aitc201906040
  8. Sperlich, M., Logan-Greene, P., & Finucane, A. (2021). “If not us, then who?”: Frontline social workers’ perspectives on gun violence. Journal of Evidence-Based Social Work, 19(1), 77–97. https://doi.org/10.1080/26408066.2021.1980478
  9. Vibrant Emotional Health. (2023). Violence Assessment and Threat Management Guidance.
  10. Pallin, R., & Barnhorst, A. (2021). Clinical strategies for reducing firearm suicide. Injury Epidemiology, 8(1), 57. https://doi.org/10.1186/s40621-021-00352-8

Implementation Examples

  • One study found success in implementing the screening question “Do you have access to guns?”2

Implementation Resources

  • None identified.

Related Strategies

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