From left: Mardi Chadwick-Balcom, Matthew Miller, Charles Morris and Thea James participate in a panel discussion.

Should health care providers be screening patients for gun ownership? What happens if a patient screens positive? What is the link between firearm access and intimate partner violence? These were some of the thorny questions explored by clinicians, researchers and community health leaders from the Brigham and beyond who spoke at the hospital’s fourth annual V-Day event on Feb. 7.

Organized by the Brigham’s V-Day Planning Committee, the wide-ranging discussion, “Gun Violence and Intimate Partner Violence: Complex Intersections,” was among the hundreds of events held worldwide this month to honor V-Day, a movement aimed at raising awareness about violence against women and girls.

Data show that 4.5 million women in the U.S. report having an intimate partner threaten them with a firearm, and nearly 1 million have been shot or shot at by an intimate partner, explained Nora Lenhard, a research assistant in the Orthopaedic and Arthritis Center for Outcomes Research. One study also found that a victim of intimate partner violence is five times more likely to be by murdered when the perpetrator has access to a firearm, she added.

Nurse-scientist Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, founding director of the Coordinated Approach to Resiliency and Empowerment (C.A.R.E.) Clinic, said statistics like these underscore the importance of maintaining momentum on addressing gun violence and intimate partner violence as public health issues requiring multidisciplinary, innovative approaches to care.

“In my career at the Brigham, I have not felt this degree of urgency nor the intentionality of the medical community as I currently do,” she said. “As an organization, our commitment to health equity through our newly articulated values is really palpable.”

Charles Morris, MD, MPH, associate chief medical officer, agreed that “the time is now” for the medical community to engage colleagues and patients on these issues. There is currently no clearly established best practice for firearm screening in a health care setting, and the Brigham is among many health care organizations across the country looking at how to best implement it, Morris added.

Speakers debated whether screening should be done indiscriminately—for example, among all primary care patients—or specifically with high-risk individuals, such as patients with a history of mental illness or gunshot wounds, and the health equity concerns the latter approach raises.
While there is a tremendous opportunity for providers to prevent harm by asking patients about the presence of firearms in their home, health care organizations are also wrestling with considerable barriers, Morris said.

“One of the biggest is what do you do if someone answers yes? It’s really complicated, and it depends mostly on where you are,” Morris said. “If you’re in the emergency room and screening a victim of firearm violence or a case where there’s an active threat, your response is going to be very different than if I am in my primary care clinic and, as a matter of course, I’m asking about seat belts and guns in the home.”

View a webcast recording of the event (Partners network access required).