Family Safety Net - Aim 3: Randomized Control Trial

The primary goal of this parallel-group clinical trial is to test the Family Safety Net (FSN) intervention in a primarily Alaska Native population in NW Alaska. The main question[s] it aims to answer are:

• Is the Family Safety Net (FSN) intervention acceptable in two formats, motivational interviewing counseling session, and scripted psychoeducational session, with a primarily Alaska Native population in Northwest Alaska?
• Secondarily, our small trial will describe signals of efficacy in improving home safe storage of firearms (unloaded, locked with ammunition separate from firearms) and medication.
• Participants will learn about the study from radio announcements or from receiving a respondent-driven sampling (RDS) coupon from another community member. We will aim to recruit an adult from at least 25% of the households in the community.
• Participants will be asked verbally if they qualify for the study, which will additionally be confirmed in the first few questions on the baseline survey, before they are consented. Participants qualify for the study if they:

1. Are 18 or older
2. Live in a home with at least one firearm
3. Live in a home where young people (under 29) spend time
4. Live in the region
5. Are the only person from their household to participate in the study
6. Have a cell phone that gets text messages

• If the participant qualifies and agrees to participate, they will be brought to a private room by the research staff. Research staff will walk through the screening criteria in the survey with the participant and go through the consent form on the iPad or on paper and answer the participant's questions. If they agree to participate, they will mark their consent, for both their participation and separately to have their session recorded, and additionally be offered a paper copy of the consent form to take home.
• Once consented, participants will be asked to complete a 10-15-minute baseline survey on the iPad. The survey will be done independently or with the help of the researcher if troubled by reading comprehension or navigating the iPad technology.
• Participants will be screened into either the lethal-means reduction-focused FSN program or the general firearm safety program based on their survey responses. If a respondent answers "yes" to one of the following questions, they are in the lethal-means reduction FSN arm of the program:

1. In the past two months, has anyone in your household been going through a rough time?
2. In the past two months, has someone in your home seemed down, sad, or depressed?
3. Are you worried that someone in your home is at risk of suicide?

They are then randomly assigned into one of two groups using a grouped randomization table:

1. The lethal means reduction MI FSN group (n=10) will:
2. Participate in a short 20-minute motivational interviewing (MI) session that includes:
3. introduction to the session and setting the agenda;
4. discussing the person's goals and strengths related to keeping loved ones safe through safe firearm and medication storage (e.g. making one's home safer to protect the youth or other family living there) and supporting wellness (i.e. mental health promotion);
5. offering normative feedback about safe firearm storage practices within the community;
6. talk about the benefits of safer firearm and medication storage practices (e.g. enhancing youth safety or avoiding youth harm);
7. action planning to increase self-efficacy to overcome barriers and move toward reducing access to firearms and medications by locking and unloading all household guns and medications; and
8. summarizing key content of the session to re-enforce benefits, goals, and values and support self-efficacy to facilitate safe firearm and medication storage practices and wellness support at home.
9. Pick out safe storage devices to take home (e.g. trigger locks, cable locks, ammo boxes, medicine boxes, mental health crisis resources, local safety resources, etc.)
10. Be told about the next steps of the study, including text messages, and follow-up survey and interview in about 4 weeks.
11. Receive 4 weeks of text messages tailored by their survey responses (1x to 4x weekly depending on baseline survey responses). They may opt-out at any time.
12. The lethal means reduction bulleted script FSN group (n=10) will:
13. Participate in a 15-minute conversation about lethal means reduction in their home, emphasizing that 10-minutes can save a life - the conversation includes discussing locations and storage of firearms, ammo, medications, and location of mental health crisis resources.
14. Pick out safe storage devices to take home (e.g. trigger locks, cable locks, ammo boxes, medicine boxes, mental health crisis resources, local safety resources, etc.)
15. Be told about the next steps of the study, including text messages, and follow-up survey and interview in about 4 weeks.
16. Receive 4 weeks of text messages tailored by their survey responses (1x to 4x weekly depending on baseline survey responses). They may opt-out at any time.
17. The general firearm safety intervention group (n=10) will:
18. Participate in a 10-minute conversation about safe firearm storage in their home including discussing locations and storage of firearms and ammo.
19. Pick out safe storage devices to take home (e.g. trigger locks, cable locks, ammo boxes, local safety resources, etc.)
20. Be told about the next steps of the study, including text messages, and follow-up survey and interview in about 4 weeks.
21. Receive 4 weeks of text messages tailored by their survey responses (1x to 4x weekly depending on baseline survey responses). They may opt-out at any time. Researchers will compare people from the same population as the general gun safety group to see if household firearm storage practices change because of the scripted conversation around gun safety.
22. The general firearm safety comparison group (n=10) will:
23. Pick out safe storage devices to take home (e.g. trigger locks, cable locks, ammo boxes, local safety resources, etc.)
24. Be told about the next steps of the study, including a follow-up survey and interview in about 4 weeks.

All participants will be compensated for their time taking the baseline survey, regardless of group assignment.

• Participants will receive two RDS coupons at the end of their session to give to people in the community who they think would qualify and like to participate.
• The participants are instructed to check back in at the end of the day or later in the week to verify if either of the people they gave coupons to came in and participated.

One month after the initial session, a link will be sent to participants via text/email to complete a 10-15-minute (depending on skip logic) follow-up survey. The follow-up survey consists of items related to firearm storage and facilitating factors hypothesized to contribute to this behavior. The survey will include items focused on mechanisms of change, including self-efficacy, and on the current household gun storage (# and type of firearm; locked/unlocked, loaded/unloaded and location of ammo for each) and actions taken to support mental wellness for others in their home. Additionally, participants will also answer questions about their satisfaction with the FSN (acceptability, cultural responsiveness). For both comparison and intervention groups, the follow-up will capture a "snapshot" of current household firearm storage practices that day.

Participants will additionally be invited at the follow-up to take part in a 20-minute phone interview (semi-structured) also one month after their initial session. The follow-up semi-structured interview consists of questions about satisfaction with the program, what participants liked and didn't like, follow-up questions on the mental health concerns they have in their home, and follow-up on what they did with the home safety equipment they brought home and why as well as how the supplies worked for them.