1. Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT) Advocacy Campaign 2013-2014

2. Annual AAP SOMSRFT Advocacy Campaign AAP Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT) annual campaign focused on advocacy Provides a framework for YOU to get involved, learn about advocacy, and implement an advocacy project of your own Successful campaigns in the past focused on smoking, vaccines, obesity, voting for kids, and childhood literacy (Read, Lead, Succeed!)

3. Why Firearm Injury Prevention? Events in Newtown, Connecticut Aurora, Colorado Virginia Tech, Virginia Personal/patient stories Injuries Gun violence exposure Suicide Homicide Public Health issue impacting children and families

4. What We Know Approximately 7.4 people per day are killed unintentionally by a gun 1 A child is killed or injured by a firearm every 30 minutes 2 33% of U.S. homes contain a gun; half don’t lock it up 3 A firearm is 22x more likely to be used in the setting of suicide, criminal assault, homicide or accidental death than in self defense 4 Risk of suicide is 5x greater if a gun is kept in the home 4 1.Injury Mortality Reports, National Center for Injury Prevention and Control, CDC, 2010; 2011 2.“CDF’s 2013 Gun Report." Protect Children Not Guns 2013. Children's Defense Fund, 24 July 2013. Web. Sept. 2013. 3.Johnson, R. "Firearm Ownership and Storage Practices, U.S. Households, 1992?2002A Systematic Review." American Journal of Preventive Medicine 27.2 (2004): 173-82. 4.Kellermann, Arthur L., Grant Somes, Frederick P. Rivara, Roberta K. Lee, and Joyce G. Banton. "Injuries and Deaths Due to Firearms in the Home." The Journal of Trauma: Injury, Infection, and Critical Care 45.2 (1998): 263-67.

5. Number of kids killed in 1 year by gun related injuries could fill 134 classrooms 1 In 2010 the # of children and teens killed by guns was ~5x the # of soldiers killed in Iraq and Afghanistan 1 Teens = most @ risk 86% of deaths and 89% of injuries from firearms happen in 15-19 year olds 1 What We Know 1. “CDF’s 2013 Gun Report." Protect Children Not Guns 2013. Children's Defense Fund, 24 July 2013. Web. Sept. 2013.

6. 31,672 Deaths 1 41,363 Hospitalized Injuries 2 42,656 Treated & Released from EDs 2 Firearm Injury Pyramid 1 Centers for Disease Control National Vital Statistics, 2010 2 Estimates from the CDC Firearm Injury Surveillance Survey

7. State and Federal Laws and Statistics Learn about your state’s current gun laws, gun death and injury statistics, and federal public health stats by visiting: AAP Division of State Government Affairs State Gun Safety Laws http://www.aap.org/en-us/my-aap/advocacy/state-government- affairs/Documents/GunSafetyLaws.pdf http://www.aap.org/en-us/my-aap/advocacy/state-government- affairs/Documents/GunSafetyLaws.pdf Children’s Defense Fund Report “Protect Children, Not Guns”: http://www.childrensdefense.org/child-research-data-publications/data/protect- children-not-guns-2013.html http://www.childrensdefense.org/child-research-data-publications/data/protect- children-not-guns-2013.html Brady Center to Prevent Gun Violence State Scorecard: http://www.bradycampaign.org/stategunlaws/ http://www.bradycampaign.org/stategunlaws/ Law Center To Prevent Gun Violence: http://smartgunlaws.org/http://smartgunlaws.org/ Centers for Disease Control and Prevention (CDC) Web-based Injuries Statistics and Reporting System (WIQARS) http://www.cdc.gov/injury/wisqars/index.htmlhttp://www.cdc.gov/injury/wisqars/index.html CDC’s National Violent Death Reporting System (NVDRS) http://www.cdc.gov/violenceprevention/nvdrs/ http://www.cdc.gov/violenceprevention/nvdrs/

8. What is Firearm Injury Prevention? A public health issue just like: Car seats Drowning prevention Bike helmets Seat Belts Child abuse prevention NOT a political issue! Not about gun “control” or gun “rights” About keeping kids/teens safe

9. Expand mental health screening and access Provide education and research about firearms Support common sense firearm legislation that protects kids Goal: Keep Kids/Teens Safe Three Main Advocacy Areas

10. How can you get involved? Continuity Clinic Community StateFederal

11. Firearm Injury Prevention: Clinic Education, research, anticipatory guidance Physician firearm counseling Discuss during well child checks Use firearm injury prevention smart phrase QI projects regarding parent education before vs. after the campaign interventions Start the discussion, bring awareness to the issue!

12. Firearm Injury Prevention: Clinic Create/distribute parent handouts i.e. AAP Connected Kids Display the 2013 P.A.V.E. poster Educational commercial/video in waiting rooms Dispensing of gun safe locks Discuss teen violence, how to to avoid it, and ways to have positive conflict resolution How to talk to children after a firearm-related injury

13. Educate Parents and Patients Safest way = no firearms in the home Discuss the dangers of guns; they are not toys ASK: Are guns in the homes where your children play? Where is it stored? How is it secured? ASK Campaign Source: healthychildren.org

14. For parents who choose to keep firearms in the home: Always keep the gun unloaded and locked up Bullets locked and stored separately Hide keys Never tell child the lock/safe’s code Discuss repercussions Advice to Parents Source: healthychildren.org

15. Strong evidence suggests that the presence of firearms in the home increases the risk of suicide among adolescents 1 Expand mental health screening and access Screen for depression and mental illness Recognize effects of toxic stress Make appropriate and timely referrals Give general and specific counseling! Firearms and Mental Health 1. Sege, Robert. “AAP Policy and Strategies to Protect Children from Firearms.” PowerPoint presentation. AAP Legislative Conference, Washington, DC. April 2013.

16. All children at risk of psychological injury Anxiety Posttraumatic stress reactions and disorder Concern when prolonged emotional response or accompanied by functional impairment Children are resilient given adequate support and counseling D Markenson, S Reynolds. The Pediatrician and Disaster Preparedness. Pediatrics 2006;117;e340. http://www.aap.org/en-us/my-aap/advocacy/workingwiththemedia/Pages/Coping-with- theAftermath-of-a-Community-or-School-Shooting Recognize the impact of firearm-related injuries

17. Guide parent to make necessary accommodations Make appropriate and timely referrals Children’s reaction based on developmental abilities 6-year-old may react by refusing to separate from parents to attend school Adolescent may attempt to hide concern, start to argue more with parents, decline in school D Markenson, S Reynolds. The Pediatrician and Disaster Preparedness. Pediatrics 2006;117;e340. http://www.aap.org/en-us/my-aap/advocacy/workingwiththemedia/Pages/Coping-with- theAftermath-of-a-Community-or-School-Shooting Counseling after a firearm-related injury: Pediatricians

18. Reassurance of safety, support, and love Strengthen child’s communication and coping skills Allow child to express feelings Mobilize resources around child Returning to the routine can be helpful, kids thrive on structure Counseling after a firearm-related injury: Parents and Teachers D Markenson, S Reynolds. The Pediatrician and Disaster Preparedness. Pediatrics 2006;117;e340.

19. Firearm Injury Prevention: Community Speak to school groups about firearms Incorporate guest speakers impacted by firearm injury Parent education at after school programs Collaborate with law enforcement, Boys & Girls Club, community centers, etc. Partner with ED/Trauma teams for high school education

20. Know your state’s laws AAP Division of State Government Affairs State Gun Safety Laws: http://www.aap.org/en-us/my-aap/advocacy/state-government- affairs/Documents/GunSafetyLaws.pdf http://www.aap.org/en-us/my-aap/advocacy/state-government- affairs/Documents/GunSafetyLaws.pdf Work with your AAP chapter to advocate for common sense firearm legislation that protects kids Find your AAP chapter reps: http://www2.aap.org/member/chapters/chaplist.cfm http://www2.aap.org/member/chapters/chaplist.cfm Firearm Injury Prevention: State/Federal Levels

21. Read AAP’s federal policy positions Contact your state and federal legislators  Support common sense firearm legislation that protects kids P.A.V.E template letter & http://federaladvocacy.aap.orghttp://federaladvocacy.aap.org Organize or participate in a firearm injury prevention advocacy day Write an op-ed or letter to the editor Firearm Injury Prevention: State/Federal Levels

22. Unified Part of the Campaign 7 th of every month Engage in social media Facebook SOMSRFT fan page Twitter (#PAVE, #PutKids1st, #KeepKidsSafe) Change profile photos to PAVE logo Email blasts Video testimonials Visit our website: http://www2.aap.org/sections/ypn/r/advocacy/PAVE.html http://www2.aap.org/sections/ypn/r/advocacy/PAVE.html

23. Organize a project at your school/program, in your community, state, or AAP district Join the SOMSRFT advocacy subcommittee Advocate through social media Participate on advocacy subcommittee conference calls How to get involved with the National P.A.V.E. Campaign

24. Helpful Resources AAP Council on Injury, Violence and Poison Prevention (COIVPP): http://www2.aap.org/sections/ipp/ http://www2.aap.org/sections/ipp/ AAP Department of Federal Affairs: www.aap.org/federaladvocacywww.aap.org/federaladvocacy AAP Mental Health Initiatives: http://www.aap.org/en-us/advocacy-and-policy/aap-health- initiatives/Mental-Health/Pages/default.aspxhttp://www.aap.org/en-us/advocacy-and-policy/aap-health- initiatives/Mental-Health/Pages/default.aspx AAP Division of State Government Affairs: http://www.aap.org/en-us/advocacy-and- policy/state-advocacy/Documents/Firearms_SLR.pdfhttp://www.aap.org/en-us/advocacy-and- policy/state-advocacy/Documents/Firearms_SLR.pdf Healthy Children.org: http://www.healthychildren.org/English/safety-prevention/all- around/pages/Gun-Safety-Keeping-Children-Safe.aspxhttp://www.healthychildren.org/English/safety-prevention/all- around/pages/Gun-Safety-Keeping-Children-Safe.aspx Brady Campaign: http://www.bradycampaign.org/stategunlaws/http://www.bradycampaign.org/stategunlaws/ Center to Prevent Youth Violence: http://www.cpyv.org/http://www.cpyv.org/ Children's Defense Fund: http://www.childrensdefense.org/programs-campaigns/protect- children-not-guns/http://www.childrensdefense.org/programs-campaigns/protect- children-not-guns/ Moms Demand Action for Gun Sense in America: www.momsdemandaction.orgwww.momsdemandaction.org

25. Acknowledgements/Thanks AAP SOMSRFT 2013-2014 Advocacy Subcommittee Toluwalase Ajayi, MD Lisa Costello, MD Shana Godfred-Cato, DO Wesley Henricksen, MD Erin Kelly, MD Ashley Lucke, MD Anita Shah, DO Natalie Stuntz, MD Lie Tjoeng, MD Elizabeth Van Dyne, MD Shannon Brockman, MS3 Neha Joshi, MS4 Christian Pulcini, MS4 Kristin Schwarz, MS4 Puja Umaretiya, MS3 Julie Raymond Barbara Miller Jamie Poslosky Kimberly Rose Batti Bonnie Kozial Katie Crumley Gina Steiner AAP Council on Injury Violence and Poison Prevention AAP Department Federal Affairs AAP Division of State Government Affairs Center to Prevent Youth Violence-ASK Campaign Children’s Defense Fund Brady Campaign

26. Thank you! Together we will P.A.V.E the way to firearm injury prevention