Emergency room intervention pairs smartphone, telehealth counseling to reduce risky firearm behavior

Among U.S. teens and young adults, firearm violence accounts for about 65,000 emergency department visits annually, and 60% of all firearm deaths in this age group are the result of interpersonal violence.

In an effort to address this growing public health crisis, University of Michigan researchers are developing novel ways to utilize healthcare visits and digital technologies such as smartphones to meet young people where they are to provide support.

One program, IntERact, is housed within the U-M Institute for Firearm Injury Prevention and uses evidence-based prevention methods to reduce risky firearm behaviors and prevent firearm injuries among at-risk youth and young adults treated in the emergency departments.

According to a new clinical trial that tested the IntERact program and published online in JAMA Pediatrics, risky firearm behaviors, such as threatening or using a gun against another person, can be significantly reduced by using telehealth-delivered behavioral counseling sessions supplemented with digital therapeutic tools via a mobile app.

The Centers for Disease Control and Prevention funded the clinical trial, which enrolled nearly 400 emergency department patients aged 16-30 who reported carrying a firearm within the past three months.

The study found that patients receiving IntERact experienced a 57% reduction in risky firearm behaviors when evaluated six months after their ED visit. This decrease was over twice the reduction observed in the comparison group that received standard care, which currently involves a social worker providing resources on local community violence and substance misuse prevention programming.

Compared with those receiving standard care, IntERact participants also experienced less overall violence involvement, fewer violent injuries, and lower rates of substance use and mental health symptoms, such as anxiety and depression.

As part of the program, within 30 days following the ED visit, patients that were randomly assigned to receive the IntERact program were provided with three telehealth sessions that offered behavioral counseling and care management support. They were also provided with digital support between telehealth sessions. The digital support, facilitated through a mobile health app, included automated daily assessments, tailored behavioral therapy content delivered between sessions, GPS-enabled high-risk location notifications, and local resource sharing.

“This new data is really promising,” said Patrick Carter, M.D., director of the Institute for Firearm Injury Prevention and professor of emergency medicine and public health. “We know that youth that engage in risky firearm behaviors are at elevated risk to injure other people or to be harmed themselves, so to see that a preventative intervention delivered in a clinical setting can decrease the risk of these behaviors, as well as associated behaviors such as substance use, that perpetuate the cycle of firearm violence, is really encouraging. Ultimately, it is about keeping young people safe and providing them with the tools they need to avoid violence.”

The study’s researchers noted that from a practical implementation perspective, digitally augmented programs like IntERact can help to remove the burden on increasingly understaffed emergency departments. And because they are remotely delivered, the programs can be integrated with centralized call centers used by other behavioral management and counseling services, extending the delivery of services to youth after a single encounter in the emergency department.

“While IntERact was initially designed for use in an emergency department, we are hopeful that with further testing and adaptation, we can begin using IntERact in other settings as well,” Carter said. “Opportunities to implement violence prevention services for youth are numerous and include other clinical settings such as primary care visits, as well as community spaces such as schools, churches and youth criminal justice programs. We need to focus on adapting programs to meet youth and young adults where they are and address the current epidemic of firearm violence with the most effective evidence-based tools we have available.”

Study co-authors: Jason Goldstick, U-M Medical School and School of Public Health; Alejandro Carrillo, U-M Institute for Firearm Injury Prevention; Laura Seewald, U-M Medical School and Hurley Medical Center; Lynn Massey, U-M Institute for Firearm Injury Prevention; Philip Stallworth, Injury Prevention Center; Maureen Walton, U-M Medical School and Injury Prevention Center; Ken Resnicow and Rebecca Cunningham, University of Minnesota; Katherine Battisti, Dayton Children’s Hospital; and Benjamin Schoener, Covenant Medical Center, Saginaw.

Study: Efficacy of Technology-augmented Behavioral Counseling for Risky Firearm Behaviors (DOI: 10.1001/jamapediatrics.2026.3893)