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Article Excerpt
Professional social work cuts across all age groups, mental health issues, and behavioral problems in a variety of roles and settings. In addition, social workers are often considered the frontline practitioners in dealing with mental health issues because the number of social workers providing mental health services in the United States is greater than that of the professions of psychiatry and psychology (Colby & Dziegielewski, 2001).Yet, these social work professionals are likely to have little knowledge about an issue that can profoundly affect clients, namely clients' safety related to ownership and access to firearms. Sherman and colleagues (2001) stated that the mental health community should emphasize managing firearm risks among clients because firearms are fairly easy to acquire and those with mental health issues are at risk of hurting themselves or others by this means. Gathering information on social workers' awareness, knowledge, and practices of assessment and intervention with clients on the issue of firearm safety holds the potential to enhance the efficacy of mental health practice in this area.
CURRENT UNDERSTANDING OF SOCIAL WORKERS ASSESSMENT AND COUNSELING PRACTICE
When mental health practitioners work with clients and their families dealing with emotional and behavioral issues, it is important that they routinely assess and provide educational intervention on the risks of keeping a gun in the home or otherwise having access to a firearm. Although many clients may not initially present in crisis, the possibility of crisis remains significant with many clients; therefore, initial assessment and counseling on firearms is a proactive practice. Suicide is rare in the absence of psychiatric illness (Beautrais, 2006), and although mental health practitioners are key gatekeepers, the U.S. Department of Health and Human Services (2001) stated that gaps still exist in specialized assessment techniques and in risk factor recognition. This report points out that whereas at-risk individuals often seek professional help, only 18 percent of suicide decedents reported suicide ideation to a health professional (Robins, cited in U.S. Department of Health and Human Services, 2001). Furthermore, as many as 90 percent of suicide decedents carry a psychiatric diagnosis at the time of death (Conwell & Brent, 1995; Moscicki, 2001),indicating the need for proper assessment and recognition of risk factors by mental health practitioners. Although the present study is focused on mental health practitioners, this issue is still relevant to community organizers and policy practitioners in the mental health community.
An effort to study the attitudes, knowledge, and behaviors surrounding client gun ownership and access has been approached within the mental health practice fields of psychology, psychiatry, and medicine. Sullivan (2004) documented the practices and comfort level of psychologists in firearm assessment and discussion with clients. Gallagher (2002) collected data on psychiatrist's knowledge, attitude, and risk assessment practices of firearm-related suicide. In the field of medicine, the American Academy of Pediatrics recommended that physicians advise patients and families on firearm injury prevention (American Academy of Pediatrics Committee on Adolescents, 1992).
Research has demonstrated that clients are receptive to clinicians' counsel in this area. Sherman et al. (2001) illustrated the effectiveness of a multidisciplinary firearm risk management program in Ohio among high-risk mental health clients who expressed intent to commit suicide by means of a firearm upon inpatient admission to a mental health facility. The program was successful in eliminating access to firearms before discharge and thus neutralized this environmental risk factor for clients. In addition, studies in the medical field have demonstrated that parents and guardians are receptive to recommendations against having guns in the home (Haught, Grossman, & Connell, 1995) and to guidance about safe storage practices (Webster, Wilson, Duggan, & Pakula, 1992). Safe storage practices have been associated with a decrease in youth homicides and suicides, as well as a decline in unintentional shooting deaths among older youths (Cummings, Grossman, Rivara, & Koepsell, 1997).
With the many avenues and settings of services, the potential of the social work profession to reduce risk related to firearm access and to counsel about safe storage practices with all clients is immense. Although other professions have been urged to assess firearm availability and advocate for the removal of firearms in their patients' homes (Brent et al., 1988; Brent et al., 1991; Kaplan, Adamek, & Rhoades, 1998), little is known about the practices and techniques that social workers use with client populations. Although it has been suggested that clinical screening for firearm access is important in reducing the risk of suicide, homicide, and injury, firearm specific education and counseling techniques are not a required component of social work undergraduate, graduate, or continuing education programs. Therefore, it is unclear what these professionals know about this issue, to what degree this type of intervention occurs, and how effective such effort is.
The primary objective of this study was to document social workers' knowledge, attitudes, and behaviors regarding client firearm safety counseling. The two primary research questions are (1)What do social workers think, know, and do about client risk associated with firearms? and (2) what preliminary factors are associated with client firearm assessment and safety counseling?
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