Design and Development of Firearm Information and Responsible Storage Techniques for U.S. Veterans (Veterans FIRST)

Suicide is a leading cause of death for U.S. Veterans. Over 70% of Veteran suicide deaths involve firearms, compared to approximately 50% among non-Veterans. Veterans are also more likely to own firearms and store them unlocked and loaded-both risk factors for firearm suicide. Barriers to the adoption of secure firearm storage among Veterans are not fully known but may include stigma related to mental health concerns and familiarity with firearms. Veteran Service Officers (VSOs), who are trusted community messengers and the initial point-of-contact for many Veterans seeking resources, have rarely been included in efforts to promote firearm safety among Veterans. We developed a stakeholder-engaged Veteran case-based curriculum designed to engage VSOs in counseling Veteran clients at risk of firearm suicide.

We utilized Design Thinking and Community Translation frameworks to engage a team of community-based stakeholders, comprised of Veterans and clinicians with expertise in suicide and community education in military populations, in four 30-90 minute feedback sessions. We led participants through a series of linked steps-including open-ended discussions and focused Design Thinking exercises-to collaboratively develop 3 sample Veteran client cases to empower VSOs with exposure to firearm safety counseling. Sessions were transcribed, and qualitative data were analyzed according to the Constant Comparative Method. This research was approved by the Mass General Brigham Institutional Review Board.

Among participants (n = 7), 57.1% were Veterans (n = 4), 28.6% (n = 2) were licensed clinical psychologists that specialized in Veteran mental health, and 14.3% (n = 1) were both. Qualitative analysis revealed 7 primary themes. First, participants described strict protocols for secure weapon storage while on active duty. Second, participants voiced an apparent disconnect between active-duty storage requirements and the dearth of such protocols as a civilian. Third, participants described a feeling of hypervigilance after discharge as an explanation for the desire to have firearms accessible. Fourth, participants described the integration of firearms into the Veteran identity. Fifth, participants voiced different generational needs and drivers of uptake of VSO services between younger and older Veterans. Sixth, participants described barriers to firearm safety education, including complacency, perceived judgment, incongruous context, and a culture of silence in the military. Finally, participants described opportunities for firearm education, including openness to information relating to firearm safety.

The contextual information and materials developed through this stakeholder-driven, iterative process will be used to implement the Veteran FIRST (Firearm Information and Responsible Storage Techniques) Intervention, a Veteran case-based curriculum that will equip VSOs with skills to counsel Veterans on firearm safety. This process enhanced our understanding of Veteran firearm beliefs and behaviors, was well-received by stakeholders, and offers promising directions for the development of future prevention efforts.