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Elizabeth Hendrickson, MD
Jennifer McCain, MD
Emma Sartin, PhD, MPH

Firearm injuries are the leading cause of death among children and adolescents in the United States, yet firearm injury prevention counseling remains inconsistently implemented in pediatric primary care. Rates of firearm-related injury and death are highest in the Deep South, where we hypothesized that unique cultural and political factors may influence counseling practices. This study sought to characterize pediatricians’ knowledge, beliefs, and practices regarding firearm injury prevention counseling in the Southeastern United States.

We conducted semi-structured qualitative key informant interviews with pediatric primary care providers practicing in Alabama, Florida, Georgia, Louisiana, Mississippi, and Tennessee as part of a concurrent mixed methods study. Participants were recruited through professional listservs affiliated with academic institutions and American Academy of Pediatrics state chapters. Interviews were conducted remotely, audio-recorded, transcribed verbatim, and analyzed using an iterative deductive-inductive thematic approach. Two trained qualitative researchers independently coded transcripts using Dedoose software until consensus was reached. Recruitment continued until thematic saturation was achieved.

Fourteen pediatric providers completed interviews. Participants unanimously recognized firearm injury prevention counseling as important but described substantial variability in counseling timing, frequency, and content. Themes clustered into physician-specific, patient-specific, and systems/resource-related barriers and facilitators.

Physician-level barriers included lack of personal firearm experience, inadequate residency training, and low confidence discussing firearm safety. Physicians who did not own firearms reported difficulty providing practical safe-storage guidance. Facilitators included personal firearm ownership, practice in smaller or rural communities, and prior experiences caring for firearm injury victims, all of which increased comfort and motivation to counsel.

Patient-level barriers included perceived caregiver defensiveness, reluctance to disclose firearm ownership, and lack of engagement with counseling. However, physicians reported that counseling was often better received among families involved in hunting or recreational firearm use and during discussions surrounding adolescent risk-taking or mental health concerns.

Systems/resource-related barriers included limited visit time and perceived ineffectiveness of current educational handouts. Facilitators included access to free gun locks, state AAP chapter educational resources, and interest in brief office-based media tools such as videos or digital educational content.

Pediatricians in the Deep South identified practical, not solely cultural or political, barriers to firearm injury prevention counseling. Interventions focused on improving residency training, increasing access to tangible resources such as gun locks, and developing realistic, regionally appropriate educational tools may improve implementation of firearm safety anticipatory guidance in pediatric primary care.

1. Identify physician, patient, and system-level translational barriers to firearm injury prevention counseling in pediatric primary care.

2. Describe facilitators associated with increased physician comfort and frequency of firearm safety counseling.

3. Discuss opportunities for implementation-focused interventions to improve firearm injury prevention.

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Maury Strong, MD
Nicholas Watkins, MD
Breanna Johnson
Jenna Joshi
Chenhao Zhao

Unintentional injury remains a leading cause of morbidity and mortality in children. The pediatric emergency department (ED) waiting room represents an underutilized opportunity for caregiver education. Digital signage offers a scalable, passive method to deliver injury prevention information without increasing staff burden; however, caregiver preferences for this modality are not well defined.

We conducted a cross-sectional survey of adult caregivers of pediatric patients in the waiting room of a Level 1 pediatric trauma center approached during business hours June-July 2025. We assessed interest in receiving injury prevention information during wait times, perceived impact on the ED experience, preferred education delivery methods, willingness to access additional information via QR code, and topics of interest. Demographic and visit characteristics were collected. Descriptive statistics were used to summarize responses, and group comparisons were performed using Pearson’s chi-squared test or Fisher’s exact tests.

A total of 500 caregivers completed the survey. Over half of caregivers expressed interest in receiving injury prevention information on digital monitors in the ED waiting room (57.2%), and 60.6% reported that such information could improve their ED experience. Digital monitors were the most preferred method of education delivery (49.2%), compared to no preference (20.2%), in-person counseling (16.8%), and paper handouts (12.6%). Additionally, 59.8% of caregivers reported willingness to scan a QR code to access additional information. Subgroup analyses demonstrated statistically significant differences in perceptions based on caregiver demographics, including age, sex, relationship to the child, education level, and socioeconomic status. Younger caregivers and those with higher levels of education were more likely to prefer digital monitors and perceive them as beneficial to their ED experience. Caregivers who preferred digital monitors were significantly more likely to report that monitors would improve their experience (88.9% vs 60.0%, p < 0.001) and expressed greater willingness to engage with QR code-based resources (81.2% vs 49.0%, p <0.001). Similar patterns were observed across multiple injury prevention topic preferences, with consistently higher engagement among caregivers favoring digital delivery methods. Across all respondents, the most preferred injury prevention topics were water safety, choking prevention, and home safety.

Caregivers in the pediatric ED waiting room most commonly identified digital signage as their preferred method for receiving injury prevention education, with nearly half selecting it over other modalities. Digital signage represents a feasible and scalable approach to delivering passive education in the ED waiting room and may enhance the overall caregiver experience. A majority of caregivers also expressed willingness to access additional information electronically via QR codes, supporting the integration of interactive components. The most preferred injury prevention topics included water safety, choking prevention, and home safety. Future work should evaluate the impact of digital signage on knowledge retention and injury prevention behaviors.

1. Caregiver preferences for injury prevention education delivery methods in the pediatric emergency department waiting room
2. Impact of digital signage on caregiver perception of the emergency department experience
3. Key injury prevention topics of interest and opportunities for integrating digital and interactive educational strategies in clinical settings

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Adiva Sahar, MD
Marisa Abbe, PhD

Firearm-related injuries are a major public health crisis in the United States, becoming the leading cause of death among children and adolescents in 2020. Despite this, firearm injury prevention education remains limited within medical training. Prior studies demonstrate that lack of knowledge, discomfort discussing firearm access, and uncertainty regarding counseling strategies are common barriers among trainees. Educational interventions have been associated with improved confidence and counseling practices. In response to these gaps, a firearm injury prevention curriculum was developed for pediatric trainees to improve knowledge, counseling comfort, and safe storage education skills.

A two-part firearm injury prevention curriculum was implemented for first-year pediatric residents during their Community Pediatrics rotation at a large academic medical center. The curriculum, developed in collaboration with the Texas Pediatric Society, included: (1) a didactic session reviewing firearm epidemiology, local and national injury statistics, principles of safe firearm storage, age-specific injury risks, and prevention strategies; and (2) interactive case-based scenarios in which participants alternated roles as physicians and caregivers to practice counseling techniques. Following each session, participants completed anonymous post-training surveys evaluating prior firearm education, perceived relevance of the curriculum, knowledge gained, and comfort discussing firearm safety. Data collected between 2021 and 2026 was analyzed using descriptive statistics.

A total of 211 participants completed the survey. Most participants were resident physicians (80%), followed by nurses and community health workers. Prior firearm injury prevention training was reported by 66 participants (31%), while 124 (59%) reported no prior formal education on the topic. Participants reported that an average of 62% of the workshop content was new information. Nearly all participants identified firearm safety counseling as highly important, and 210 participants (99.5%) agreed that counseling on safe firearm storage can help prevent unintentional firearm injuries.

Comfort discussing firearms in the home improved substantially following the workshop. Before the training, 83 participants (39%) reported feeling somewhat or very comfortable discussing firearms with families, compared with 195 participants (92%) after the workshop. Overall, 168 participants (80%) demonstrated increased comfort levels, while only 2 participants (<1%) reported decreased comfort. Additionally, 194 participants (92%) correctly identified recommended safe firearm storage practices, including storing firearms unloaded and locked with ammunition stored separately.

Implementation of a structured firearm injury prevention curriculum for pediatric trainees was feasible and associated with improved participant comfort and knowledge regarding firearm safety counseling and safe storage practices. Educational interventions such as this may help address critical gaps in physician preparedness and strengthen injury prevention efforts in pediatric healthcare settings.

1. Describe barriers to firearm injury prevention counseling among healthcare trainees.
2. Identify key components of an effective firearm injury prevention educational curriculum.
3. Evaluate the impact of firearm safety training on participant knowledge and counseling comfort.

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David Kling Jr, DO
Kat Lehman, MD
Serena Dow, MD
Lydia Hanson, MD
Evelyn Gartstein, DO
Dana Paine, MD
Sara Helwig, MS
Sarah Denny, MD

As states legalize cannabis, there has been a corresponding increase in unintentional cannabis ingestions in children under seven years old. Children experience more severe symptoms than adults following cannabis overdose. This study examined whether providing cannabis poisoning prevention counseling and home safety devices in a primary care setting influences caregivers’ safe storage practices.

Caregivers of children under seven years old who consented to participation during routine clinic visits were counseled on safe storage of cannabis and dangers of unintentional ingestions while also being provided with a lock bag for safe storage. The study occurred at pediatric clinics affiliated with a tertiary care children’s hospital from September 2024 to December 2025. A pre-survey followed by a one-month post-survey were completed to assess caregiver behaviors and knowledge about safe cannabis storage. Data was analyzed by a statistician using R statistical software.

A total of twenty-five respondents completed the pre-survey for inclusion in this study, and Twelve respondents completed the post-survey. Only 44% of participants reported receiving counseling about cannabis ingestions prior to this study. At one-month follow up, 86% of caregivers who disclosed storage locations reported storing marijuana in safe locations, compared to 23% of caregivers at the time of initial intervention. Seventy-five percent of respondents reported a better understanding of dangers of cannabis ingestion in young children post-intervention.

Cannabis safety education is a feasible and effective injury prevention intervention in the primary care setting; it improves caregivers’ knowledge about cannabis poisoning in young children and promotes safer cannabis storage behaviors. As cannabis becomes increasingly available to the public, it is important for clinicians to acknowledge the prevalence of cannabis in households with young children and to educate caregivers on potential risks.

1. Describe current trends and risks associated with unintentional pediatric cannabis ingestions, including factors contributing to increased exposures in young children.

2. Identify effective primary care–based strategies for cannabis poisoning prevention counseling and safe storage education for caregivers of young children.

3.Evaluate the impact of caregiver education and provision of home safety devices on improving cannabis storage practices and caregiver knowledge in the outpatient pediatric setting.

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Marlee L. Hepler, BSPH, MHA, CPST
Adrienne R. Gallardo, BSW, MAOM, CPST-I
Ben Hoffman, M.D., CPST-I, FAAP

Our Infant Safety Program was developed in response to published research from 2014, which found that 95% of families had at least one form of car seat misuse. In 2016, an Injury Prevention Educator was hired to provide infant safety education on the postpartum unit. This initiative aimed to reduce misuse rates and introduce the importance of injury prevention before transitioning home from the hospital.

The Injury Prevention Health Educator position was created to provide comprehensive infant safety education, including car seat safety, safe sleep practices, and home safety, as well as to distribute essential safety items to families in need. The program currently includes three Injury Prevention Health Educators who serve patients in the well newborn units and NICUs at two hospitals, in addition to supporting community members. This program is funded through our hospital Foundation, private donations, the Oregon Department of Transportation, Buckle Up for Life, and the CPASS project. The Infant Safety Program offers interpretation services and car seat and safe sleep educational materials translated into 25 languages. Every family who receives inpatient services is given an infant safety gift, which includes a sleep sack swaddle, cabinet locks, outlet plug protectors, a reusable tote bag, and educational materials. For families who do not have a car seat, a safe sleep space, or necessary home safety products, the program can provide these resources along with hands-on education to ensure proper use. The team also conducts safe sleep audits on inpatient units to promote and reinforce safe sleep modeling during hospital stays. Community outreach efforts began through the Community Partnership Program for Safe Sleep (CPASS), a collaboration between our team and a community partner serving Black families. This program uses a train-the-trainer model to deliver culturally responsive education. Safe sleep recommendations from the AAP are shared by community partners, with support from our team, at community baby showers. Families who attend these events receive a portable crib or bassinet, along with a fitted sheet, Halo sleep sack and pacifier.

In 2025, 3,313 families were served on the main hospital birth unit, 464 families were served in the main hospital NICU, and 645 families were served at the second hospital's birth unit and NICU. This represents a 19% overall increase in the number of families served from 2024 to 2025. Additionally, 162 safe sleep kits were distributed in the community at outreach events. Our community outreach model extends services beyond our hospital system and reaches some families who deliver at other hospitals. In the Portland metro area, we are the only organization among 15 delivering hospitals providing this level of infant safety education and resources.

Unsafe sleep environments are the leading cause of preventable death, and motor vehicle crashes are the third leading cause, for infants under one year of age in the United States. Our Infant Safety Program provides hands-on education and resources to families in the Portland metro area, introducing injury prevention from the very beginning.

Objectives:

1. Describe the Infant Safety Program model and services
Attendees will understand how the program delivers education, resources, and support to families across hospital and community settings.

2. Apply train-the-trainer model when educating underserved populations
Attendees will learn how to apply the train-the-trainer model and why it can be beneficial to deliver culturally responsive education.

3. Building relationships with multidisciplinary departments and community partners
Attendees will learn the importance of building relationships with different disciplinaries in hospital settings and community partners to better serve the community.

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Alicia Melven, MPH, CCHW, CPST
Amanda Abramczyk-Thill, MPH, CPST-I, STAC-I

Unintentional injury remains a leading cause of morbidity and mortality in children in Colorado and nationwide. However, most pediatric hospitals lack structured inpatient interventions that provide families with actionable safety behavior changes after a traumatic injury. To reduce reinjury risk and strengthen early prevention education, we piloted a formal injury prevention rounding model designed to standardize education, reinforce safety behaviors, and reduce future injury risk.

Two years of Trauma Registry data at a Pediatric Level 1 Trauma Hospital were evaluated to identify leading mechanisms of injury and determine priority education topics by age group. The Injury Prevention Specialist (IPS) created an inpatient rounding process, including workflows, inclusion and exclusion criteria, and scripted key messages for families.

The IPS rounded on admitted trauma patients after creating a rounding program based on the injury prevention best-practice model. Key elements of this process included creating a standardized rounding workflow and developing patient inclusion and exclusion criteria. Another step in developing this program was drafting scripting for patients and families based on motivational-interview style communication; these scripts included education content as well as how to elicit participation and goal setting. We also worked with our Electronic Health Records (EHR) team to create an injury prevention flowsheet and consult notes for transparency as well as a way to monitor progress.

A final step in the implementation process was designing family-centered educational materials that were available in English and Spanish. These materials were designed to supplement verbal education and summarize key safety messages. We also worked to ensure we had a process for system-wide tracking and review so that evaluation could occur for process improvement and understanding the institutional impact of inpatient rounding.

From November 1, 2025, to April 28, 2026, 105 trauma patients (ages 1 month – 18 years) and their families received injury prevention education in the form of inpatient rounding from the IPS. This education covered 22 different injury prevention topics, with over 300 supplemental educational resources provided in both English Spanish. Topic distribution aligned with leading injury mechanisms in the Trauma Registry, including non-accidental trauma, winter sports, wheeled safety, falls, and motor vehicle collisions. Implementation demonstrated a high feasibility for sustainable implementation as well as organizational support for increased injury prevention inpatient education.

Direct one-on-one education of patients and caregivers is considered best practice for injury prevention and offers the most opportunity for long-term safety behavior change. Thus, offering this model of secondary prevention during hospitalization can seek to prevent high-risk safety behaviors from reoccurring after the patient is discharged. Next steps include evaluating behavior change, assessing reinjury outcomes, and expanding integration throughout the trauma program.

1. Understand the role that inpatient injury prevention plays in promoting safety behaviors for admitted patients and their families.

2. Describe how the Trauma Registry data was used to inform injury prevention inpatient rounding.

3. Discuss best practice for hospital-based injury prevention rounding.

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Kristen Volz-Spessard, MS
Jennifer Tabak, RN, MSN, CEN, CPEN
Susanne Clark, LCSW
Brendan T. Campbell, MD MPH, FACS
Steven C. Rogers, MD, MS

The American College of Surgeons (ACS) requires that all Level 1 Trauma Centers screen patients who may be at-risk for mental health problems. This is based on reports that trauma patients one-year post-injury often develop Post-Traumatic Stress Disorder (PTSD) (21%) and depression (6%). Therefore, screening is critical to ensure patients are identified and receive appropriate resources to limit or prevent the impacts of traumatic injury on youth mental health. The Acute Stress Checklist – 6 (ASC-6) is a validated brief screening tool that measures acute traumatic stress reactions/disorders in children and adolescents. This tool can be completed in less than 2 minutes and can be easily completed by a social worker or psychologist. Our free-standing Children’s hospital is a designated Level 1 Pediatric Trauma Center that evaluates and treats more than 60,000 patients each year. To address the recent ACS requirement and improve engagement in mental healthcare for trauma patients we developed a screening program incorporating the ASC-6 to screen eligible patients including a quality review process. The screening program was established in February of 2026. This program evaluation aims to describe the preliminary results of those screened to date using the ASC-6.

Patients eligible for screening are 8 to 25 years old, mentally capable and medically stable, admitted to Trauma Service (>24 hours), and experienced an acute injury or trauma with a Trauma Team activation. Patients’ answers are based on a numerical assigned response of “Never/Not true = 0”, “Sometimes/Somewhat = 1”, or “Often/Very True= 2.” Patients who screened positive on the ASC-6 with a score of 6 or higher are referred to psychiatry for an additional mental health evaluation. ASC-6 screening results and demographic information were analyzed using Microsoft Excel. Additional screening data will be analyzed using appropriate statistical analysis (i.e. chi square) to describe/report significant demographic and screening result associations.

Between February 2026 and May 2026 there were 24 patients who were admitted to the Trauma Service. There were 23 patients eligible to be screened with the ASC-6, and 1 patient who was not mentally competent. Of the 23 patients, there were 5 positive screens (22%) and 18 negative screens (78%). All screened were mostly 17 years old, were male (70%), identified as White (74%), and Medicaid insured (48%). Positive screens were mostly 15 years old, were male (60%), identified as White (60%), and Medicaid insured (60%). By November 2026, we expect to analyze and report on the screening results of over 60 patients admitted to the Trauma Service.

Therefore, by incorporating a mental health screening program into patient care, this enables Trauma Centers to identify patients who may be at-risk for mental health concerns and connect those with positive screens to appropriate resources which may reduce suffering from mental health disorders and/or risk of suicide following a significant traumatic injury

1. Understand the importance of screening/identifying trauma patients for mental health concerns
2. Describe statistically significant associations for screening results and patient demographics to help inform quality improvement efforts
3. Improve engagement in mental healthcare for trauma patients in need

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Kristyn Jeffries, MD, MPH
Conor Smith, MD
Melissa Wood-Katz, MD
Imani T. Hasan, MHA
Valerie Harfield, MHSA
Jason Williams, PsyD, MSEd

Suicide is the second leading cause of death for adolescents age 15-19 years in the United States.?Evidence-based?suicide prevention strategies - such as lethal means counseling (LMC) with families at risk of suicide – can help reduce access to firearms and other highly lethal means during an acute crisis period. Our primary aim was to increase documentation of LMC?in the emergency department from baseline of 26% to goal of 46% within 12 months.

This QI project was part of the AAP’s?Improving Mental Health Processes, Workflows, and Responses (IMPWR) project. The results presented are from a single-center, tertiary children’s hospital with a multidisciplinary behavioral health team. Patients?aged?12-17 years who presented to the emergency department with a mental health complaint were included. Patients with autism, developmental delay, and eating disorders were excluded. The primary outcome was percentage of patients with documented LMC. Baseline data were obtained from April 2023-March 2024. We used Plan-Do-Study-Act (PDSA) cycle?methodology?to?identify?barriers and implement improvements during the intervention period of April 2024-March?2025. Interventions included providing?LMC?education to social workers,?adjusting?the social work note?template and?implementing?a standardized safety plan.??Statistical process control charts were used to identify special cause variation.

Data were obtained from 2475 charts of adolescents presenting with mental?health complaints: 859 in the baseline period and?1616?in the intervention period. The?mean percentage of patients receiving LMC?increased from?26% to?56% after interventions, meeting special cause variation (Figure 1). ?This increase in LMC documentation was sustained for the following 5 months after project completion. Despite this overall improvement, sub-analysis identified a persistent equity gap in which White patients disproportionately received LMC more often than Black patients (45% vs 35%, p< 0.01).

Using QI methodology to standardize note templates and safety planning resources, we achieved our goal to increase documentation of LMC in the emergency department. These strategies may be helpful to other hospitals to improve the care provided to this at-risk population. Future interventions at our institution will aim to reduce the racial disparities identified in our LMC documentation.

1) Describe baseline gaps and disparities in lethal means counseling for pediatric patients presenting to the emergency department with mental health complaints.
2) Discuss barriers and facilitators to implementing standardized lethal means counseling workflows in acute care environments.
3) Identify key quality improvement interventions used to increase rates of lethal means counseling in the pediatric ED setting.

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Adrienne R. Gallardo, BSW, MAOM, CPST-I
Chelsea M Heisler, BS, CCRP
Kyle P. Johnson, MD
Christina Anderson, LCSW
Bobbie Hildreth, MN, RN, CPN
Judith A. Guzman-Cottrill, DO
Catlin Dennis, MPH

Doernbecher Children’s Hospital’s (DCH) Injury Prevention Program (IPP) provides safety resources - including medication lockboxes, firearm lockboxes, and firearm locking devices - along with targeted injury prevention education to patients presenting with acute mental health crises. This intervention is initiated either through an Emergency Department (ED) provider’s IPP consult order or during routine IPP inpatient rounds. An assessment was completed of the proportion of eligible patients who received an IPP consult and associated safety products. In addition, evaluation of the program’s impact was conducted through interviews with patients and their families.

A retrospective chart review was conducted of all patients under 18 years of age who were evaluated in the Doernbecher Children’s Hospital (DCH) Emergency Department (ED) or admitted to inpatient units for an acute mental health crisis between March 1, 2023, and September 30, 2024. The review assessed the number of patients for whom an Injury Prevention Program (IPP) consult was requested, the proportion of consults that resulted in an IPP intervention, and the number of patients who accepted or declined safety products. Qualitative feedback was obtained from families through a standardized telephone survey. Survey questions focused on the use of provided safety products in the home and families’ perceptions of the impact of the IPP consultation.

A total of 810 patients were eligible for IPP consult during the study period. Of these, 26% (210/810) had a consult order placed by the provider and the IPP responded to 206/210 (99%) of orders placed. Of the orders received, 86% (180/210) of families received at least one safety product. An additional 40 patients were identified by the IPP and received products without an order; thus, a total of 220 received products. 43% (94/220) of families were successfully reached via telephone, and of these families 62% (58/94) completed the phone survey. Most (90%, 52/58) reported that some or all safety products they received were used or remain in use, and 98% (57/58) found them to improve their child’s safety following discharge.

Our IPP consulted on 26% of eligible patients, suggesting that we can improve ED provider awareness to order IPP consults for all eligible patients, or create an automated order within ED work workflow and emphasize the importance of placing IPP orders for education and resources. Nearly all families found value in the IPP consults which were durable: the majority reported continued use of safety products at home beyond the child's acute crisis. A study limitation is possibly missing IPP interventions during chart review. Survey limitations included unanswered phone calls, outdated contact information, and parents' limited times. Future efforts will focus on continued program and product investment and growth, as our findings indicate a meaningful impact on patient safety.

1. Providing safety resources to caregivers prior to discharge can reduce barriers during an acute crisis and support the development and implementation of a safe discharge plan for pediatric patients.

2. Delivering injury prevention education and resources during a time of crisis has the potential to significantly enhance a child’s safety in the home environment.

3. Collaboration between the Injury Prevention Program and Child Psychiatry enables the delivery of comprehensive, coordinated services and resources to support pediatric patients and their families.