How to Counsel

Learn how to effectively assess risk, talk with patients about access to firearms, and intervene appropriately

Engaging in culturally appropriate and respectful conversations with patients and making evidence-based recommendations can increase the safety of everyone living in homes with guns.

Clinicians routinely ask patients about lifestyle choices that affect their health and safety and that of their families, like diet, exercise, use of car seats, and secondhand smoke. Additionally, patients generally view their healthcare provider as a trusted source of information about their health and safety and that of their family.^1,2 Many clinicians, however, do not talk with patients about the risks of firearms in the home, even when it’s clinically indicated.^3-7

Clinicians can easily learn the basics about firearms, risks associated with access, and potential interventions in order to have knowledgeable conversations that result in realistic and acceptable plans to reduce the risk of gun injury.

No state or federal laws prohibit clinicians from asking their patients clinically-relevant questions about firearms.

Addressing Barriers to Counseling

Clinicians across specialties cite similar barriers to discussing firearm injury prevention with patients, including lack of knowledge on the topic, concern about how such discussions would be received, and lack of time.^8-13

Despite concerns about alienating patients, research suggests that people are receptive to these conversations: 67% of individuals and 54% of gun owners say it’s generally appropriate for healthcare providers to talk with their patients about firearms.¹⁴ Furthermore, evidence suggests that larger proportions of individuals think conversations about gun safety are appropriate when the patient or someone in the patient’s home is at increased risk (84%-91%, depending on the risk factor).¹⁵

For clinicians who are concerned there isn’t time to cover everything during each appointment, we recommend a risk-based approach. Some populations that clinicians see, like parents or caregivers of small children, warrant universal counseling, but for others, counseling about firearm injury prevention may be a lower priority that is only warranted when indicated.

The 3A’s Framework can help guide clinicians in clinical situations where firearms pose a risk of harm.

The 3A’s (Approach, Assess, Act) Framework is designed to guide clinicians through the process of talking with patients about firearm injury prevention. Practicing the 3A’s will help clinicians build rapport with patients and develop realistic and acceptable plans to reduce their risk of firearm injury. Each of the A’s has four elements.

The four elements of Approach are:

The first A is Approach. Conversations about firearm injury prevention will be more effective if clinicians frame them in the context of risk reduction. These conversations are about the patient’s and clinician’s shared interests – the safety and well-being of the patient, the people in the household, and in some cases, their communities. The goal is to increase safety by reducing access to firearms for people at risk.

The four elements of Assess are:

The second A, Assess, will help clinicians determine whether it’s clinically relevant to ask about access to firearms, and, if such a discussion is indicated, how to ask about access and then gauge willingness to work together on reducing risk.

The four elements of Act are:

The third A, Act, identifies the actions that clinicians can take to help prevent firearm injury based on the level (low, medium, high) and type (e.g., self-harm, unintentional injury, harm to others) of risk. Please note that these are broad recommendations and that the interventions may apply differently than is expressed in the examples presented here.

Follow up with continued discussions

Risk for firearm injury is dynamic; circumstances in the home can change over time, as can risk. Patients may experience a suicidal crisis, a relationship may become violent, or an infant may grow into a curious toddler. Presence of firearms in the home and how they’re stored may change. Checking in with patients at future visits about changes in risk keeps the conversation about firearms open and allows for continued rapport building so clinicians and patients can work together to prevent firearm-related harm.

Page last updated June 2022.

Episode 12 – The 3A’s Framework for Reducing Firearm Injury

Dr. Amy Barnhorst introduces the 3A’s Framework, designed to guide clinicians through the process of identifying patients at risk for firearm-related harm and reducing their risk through appropriate interventions.

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Episode 3 - How to Counsel

This third episode of the explainer video series highlights how to have informed and respectful conversations with patients about the risks of firearm access and how to reduce that risk.

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Preventing Firearm-Related Injury and Death: A Targeted Intervention

This 45-minute video walks through how to talk with patients about firearm-related harm and is available for free CME credit.