Study Reveals Opportunities to Engage Maryland Clinicians in Utilizing ERPOs

One promising tool for gun violence reduction is extreme risk protection order laws, which temporarily prohibit people who are behaving dangerously and at risk of committing violence from purchasing and possessing guns. In jurisdictions with ERPO laws, there are people and systems in place to ensure that implementers know about ERPO and receive the support they need to use it. Our Implement ERPO website documents examples of how ERPO implementation is working. 

When Maryland became the first state to authorize clinicians as ERPO petitioners in October 2018, our team of Johns Hopkins researchers and practice partners wanted to know how ERPO would translate to the clinical setting. The ability of clinicians—including physicians, psychologists, clinical social workers, and several others—to file ERPO is important, as intent to harm oneself or others with a firearm is often revealed in the clinical setting. 

We developed a brief survey to understand what Maryland clinicians know about ERPO and how they have used ERPO in the past and could use it in the future; the survey also asked clinicians to identify barriers to their use of ERPO as well as strategies for addressing those barriers. We invited clinicians from the departments of emergency medicine, pediatrics, and psychiatry at the Johns Hopkins Hospital in Baltimore, Maryland, to participate. 

The responses from physicians are available in the December 20, 2019, issue of JAMA Network Open. The findings highlight an interest in using ERPO to reduce patients’ risk of violence, concerns about how ERPO can be applied in the clinical setting, and strategies for addressing those concerns. 

A few highlights from the paper:

• Of the 92 physicians who responded, one (a psychiatrist) reported filing an ERPO.
• 72% of respondents reported being “not at all familiar with ERPOs.”
• After reading a brief description of ERPO, almost all (92%) of the physicians in our sample reported seeing patients at least a few times a year who they would consider for an ERPO; 60% indicated they would be “very or somewhat likely” to file a petition when caring for a patient who meets the ERPO criteria for dangerous behaviors.

While physicians report treating patients who they believe are at risk of suicide or inter-personal violence and say they would consider using ERPO to minimize those risks, they also identified significant barriers to using ERPO in their clinical practice.

• Time to complete the ERPO petition and time to testify in court were the main challenges cited by 63% and 70% of the physicians who responded, respectively.
• 40% of respondents indicated concern that filing an ERPO may negatively affect their relationship with their patient, with over half (53%) of psychiatrists identifying this concern as a barrier.

To address barriers to ERPO use in the clinical setting, the physicians who responded to our survey identified several strategies.

• 87% responded positively to the idea of having a clinical coordinator who could manage the ERPO petition process. 
• Training about ERPO, participating in court hearings remotely, and having access to legal counsel were also identified as helpful by 86%, 74%, and 64% of the physicians who participated, respectively.

These survey findings provide a first look at how physicians are thinking about ERPO in the clinical setting. The findings inform ways to support physician use of ERPO and can inform ERPO implementation work in Hawaii and DC, where clinicians are also authorized as ERPO petitioners. Making sure ERPO is being utilized in a way that maximizes patient and public safety is an important component of ERPO implementation.

Read the paper in JAMA Network Open.