Preventing Firearm Injury in the Greater Houston Area through Purpose and Policy: A Review

On June 21, 2022, the Center for Health and Biosciences at the Baker Institute for Public Policy hosted its first annual Firearm Injury Prevention and Safety (FIPS) symposium. The symposium brought together more than two dozen researchers, state legislators and community partners with the ultimate goal of highlighting local research efforts in firearm injury prevention and public health-based community interventions. Participants also discussed new and innovative strategies to address firearm injury and violence in the greater Houston area and beyond. The presentations ranged from personal anecdotes to academic findings and culminated in a legislative panel discussing how policymakers can support interventions and take action to reduce firearm violence in Houston.

This report offers a summary of the presentations at the conference, as well as an overview of the four main policy recommendations that emerged from discussions held at the event.

Overview of the Current State of Firearm Violence in the Greater Houston Area

Houston Mayor Sylvester Turner kicked off the symposium with a welcome address and an overview of the One Safe Houston initiative. One Safe Houston was launched in early 2022 by Houston’s Office of Policing Reform and Accountability as a comprehensive violence reduction initiative that utilizes research-based strategies to improve public safety and reduce the harms caused by violent crime. Turner observed that the FIPS annual symposium and One Safe Houston share the goal of bringing together stakeholders dedicated to reducing violence, preventing crime and strengthening crisis intervention, response and recovery. Turner also described One Safe Houston’s focus on implementing youth outreach opportunities and establishing key partnerships in communities affected by firearm violence.

Following Turner’s address, Dr. Bindi Naik-Mathuria, a pediatric trauma surgeon and a FIPS fellow at the Baker Institute, offered a comprehensive overview of gun violence and firearm injuries in Houston. She also presented her findings on the epidemiology of firearm injuries in the greater Houston area and explained the various types of injuries in both adults and children, including injuries from unintentional shootings, suicides, school-based shootings and interpersonal violence. Dr. Naik-Mathuria emphasized the importance of recognizing the number of nonfatal firearm injuries — not just the firearm injuries that lead to death, which generally control the gun violence narrative. She noted that nonfatal injuries can cause long-term physical disability and psychological trauma to victims and their family members. In fact, in Houston, nonfatal firearm injuries are three times more common than firearm deaths among children, and two times more common among adults.

Additionally, Dr. Naik-Mathuria discussed the considerable increase in firearm injury and death since the start of the pandemic, noting various correlations in injury distribution and social characteristics at the individual and neighborhood levels. For example, among adults in Houston, homicides are more common than suicides, a trend that differs from national data. Moreover, unintentional shootings account for 20% of childhood injuries and deaths in Houston, and more than 80% of unintentional and suicide shootings involving children occur at home.

Ned Levine, a nonresident fellow for the Center for Health and Biosciences at the Baker Institute, elaborated on firearm violence trends in Houston over the past several decades, and discussed his work on the geospatial analysis of gun-related crime in the greater Houston area. He hopes this research will guide the implementation of strategies to reduce the frequency of firearm injuries in the city.

Session I: Unintentional Shootings

The first session of the symposium reviewed data surrounding unintentional shootings with a focus on research-based findings that can improve firearm safety, rather than partisan approaches to gun violence.

Dr. Sandra McKay, a pediatrician researcher with McGovern Medical School at UTHealth and a nonresident FIPS fellow at the Baker Institute, discussed the lack of programs to teach safe firearm storage to health care providers and community members. While health care providers are looked upon to provide firearm safety messaging, few receive formal training in this area. In reality, only 1 in 3 residency programs offer formal firearm counseling training. At the same time, firearm owners report that they generally look to family, law enforcement, firearm retailers and health care providers for information on firearm safety. Dr. McKay emphasized that health care providers must work to identify additional venues for messaging about safe storage through novel community partnerships and by utilizing the framework of the “trusted messenger.” Additionally, McKay pointed to research indicating that safe storage counseling is most effective at the point of firearm sale. Based on this, health care providers should develop partnerships with community-based groups to encourage safe storage counseling at places where firearms are sold, she said.

Temporary voluntary storage locations, which Houston urgently needs, can also reduce unintentional shootings and suicides, Dr. McKay reported. This would provide families with out-of-home options for storage and could be especially useful for those who do not have adequate storage options available to them, or for those in a time of crisis. In collaboration with Dr. Zoabe Hafeez from the McGovern Medical School at UTHealth, Dr. McKay aims to use geospatial mapping to identify areas that experience a high number of firearm injuries and also lack temporary storage locations. This work will guide the placement of new temporary storage locations. Dr. Hafeez also discussed the importance of comparing firearm injury data with existing datasets, like the social vulnerability index, to develop predictive models that can guide interventions such as safe storage campaigns.

Gun safety advocate Leesa Ross followed with a personal account of her son who died as a result of an unintentional firearm discharge. In response to her son’s death, Ross created Lock Arms for Life to educate firearm owners and community members about gun safety and the safe storage of firearms. When firearms are not in use, it is crucial that they be stored, locked and unloaded, to keep everyone safe — owners and non-owners alike, she said.

Session II: Firearm-related Suicides

The second session transitioned to a discussion about firearm-related suicides and the role of mental health in firearm discourse. Gala True, an associate professor at Louisiana State University School of Medicine, introduced her research on suicide prevention among veterans. She described her team’s success in building a diverse coalition of firearm safety stakeholders. Early alignment in the coalition was crucial to dispel myths surrounding veteran suicides and combat reluctance among firearm owners who felt that this sort of coalition would threaten their right to bear arms, she said. True further explained the importance of trust, rapport and stakeholder buy-in to administer more effective injury and suicide prevention interventions.

Access to high-quality mental health care is another key component to consider when looking at suicide prevention, said Dr. Laurel L. Williams, a professor at Baylor College of Medicine. She reviewed the success of the Texas Children’s Mental Healthcare Consortium (TCMHCC), a Texas-wide legislative effort created by S.B. 11 that features the Texas Child Health Access Through Telemedicine (TCHATT) program and the Child Psychiatry Access Network (CPAN). TCHATT offers mental health care access through school mental health services, and CPAN offers phone consultations to clinics across Texas that may lack in-house mental health expertise, Dr. Williams explained. TCMHCC is a strong example of the possible partnerships that can be forged through legislation to promote improvements in mental health care access and treatment.

Session III: School-based Violence

During the third session of the symposium, presenters addressed school-based gun violence. Jeff Temple, from the University of Texas Medical Branch (UTMB), reviewed teen dating violence and its relationship to firearm violence. He explained that through workshops and conferences at UTMB’s Center for Violence Prevention, health care experts have the opportunity to discuss ethics, policy and prevention practices related to firearm injury prevention.

Shannon Guillot-Wright, who also works with the UTMB Center for Violence Prevention, focused on the importance of translating research into policy. As part of the Research to Policy Collaborative, she explores how to effectively move from empirical evidence to data-driven policy applications. Her work found that policymakers prefer small, digestible bits of evidence in which to ground their decision-making. Making slight adjustments to the way research is disseminated to policymakers has the potential to improve research applications in policy, she said.

Session IV: Interpersonal Violence/Assault and Community-Based Interventions

The fourth session addressed interpersonal violence and assault, as well as community-based interventions. Dr. Catherine Seger, a surgeon from Baylor College of Medicine, shared her own perspective as a trauma surgeon. Her account of workdays filled with back-to-back cases of firearm assault victims portrayed the devastation wrought by gun violence. She discussed not only the sheer destruction of a victim’s body from a firearm injury, but also the impact on the families, friends and health care teams working to care for them. One of the ways to prevent or reduce violence-related injuries is through the integration of hospital-based violence intervention programs, Dr. Seger said. Ben Taub Hospital is currently in the early stages of implementing such a program, she noted, and more hospitals should follow suit.

Beyond hospital and institution-wide interventions, this session highlighted a number of community-based efforts to reduce gun violence currently underway in Houston. While the Baker Institute serves as a bridge between research and politics, it also strives to build bridges into the Houston community. It is imperative that research goals in the academic community and policy goals in the Texas Legislature stay attuned to the needs of the communities that they serve. Several intervention leaders and program administrators presented on their work in Houston, highlighting the progress made toward reducing firearm violence:

• Lupe Washington, director of the Community Health and Violence Prevention Services in Harris County, discussed her work with the Holistic Assistance Response Team (HART). HART is designed to respond to nonviolent calls related to mental health. Separately, she introduced her work with the Community-Based Violence Interruption Program. This program utilizes a “credible messenger” model to reduce violence in the community. Washington also leads Harris County’s new Hospital-Based Violence Intervention Program.
   
• Karlton Harris presented on his work with an organization called The Forgotten Third. The mission of The Forgotten Third is to reduce crime and violence by providing a second chance to youth and young adults through a comprehensive public health approach. The program also provides a Credible Messenger Mentoring Program to underserved youth.
   
• Crystal Okorafor, deputy inspector general of Houston’s Office of Policing and Reform and Accountability, presented an overview of the One Safe Houston program. One Safe Houston focuses on crisis intervention response and recovery and expands support for mental health crisis interventions, domestic violence prevention, gun buyback programs, patrol enhancements and park supports. The program is comprehensive and has demonstrated a significant reduction in local homicide rates in the region, said Okorafor.

• LeTosha Selexman discussed her role as the director of the City of Houston Community Reentry Network Program. This program was sponsored by the Houston Health Department in 2008 to prevent, disrupt and stop the spread of gang-related violence. The Community Reentry Network has successfully partnered with community-based programs to pair mentors and guides with youth and young adults who are at a high risk of reoffending or engaging in gang activity.
   
• Victor M. Gonzalez, Jr. is the division manager of the Mayor’s Office of Gang Prevention and Intervention for the City of Houston. The program strives to prevent gang involvement and juvenile delinquency through partnerships with service organizations while bridging the gap between communities, law enforcement and criminal justice agencies.

Session V: Policy Action

The conference concluded with a panel on opportunities for firearm injury prevention policy in Houston. Dr. Sandra McKay moderated the panel and started with an overview of existing bills and court rulings that have impacted firearm purchasing patterns. She also considered how the COVID-19 pandemic has impacted such patterns and outlined factors that drive legislative change related to gun violence.

The panel featured Harris County Sheriff Ed Gonzalez, Texas State Representative Ann Johnson, Harris County District Attorney Kim Ogg and Texas Senator John Whitmire. The panelists considered numerous topics including child access protection laws, post-Uvalde responses and future policies to keep children safe from firearm violence in schools. The panelists also proposed policy recommendations such as raising the purchasing age to 21 years for semiautomatic rifles, prosecuting violations of child access prevention laws, and implementing extreme risk protection orders in instances where individuals pose an imminent threat to themselves or others.

Throughout the panel discussion, the panelists emphasized the importance of voting and engaging in the legislative process. “Change is possible if we all stay ‘fired up’ and take part in ending firearm violence,” concluded one panelist.

Policy Recommendations

The symposium gave rise to clear policy recommendations from science and community experts. Four general policy themes emerged that could reduce firearm injury and ultimately save lives, if prioritized by community partners and the Texas Legislature. The four themes are outlined below:

1. Prioritize Safe Storage. Safe firearm storage is effective in reducing unintentional injury and suicide, especially in the greater Houston area where firearm injuries and deaths are so prevalent. Public awareness campaigns, as well as education programs within the health care sector and at the point of sale, should be promoted and supported. Improved access to safety devices through community-based gun lock give-away programs should be expanded. Such programs should also include safe storage education. Child access prevention laws should be fully enforced and modified to reflect a penalty in cases where a child may access a firearm. Waiting until a child has accessed a firearm can result in irreversible injury or death to the child or another person, and therefore it is imperative to have laws that are preventative. Health care providers should be required to report all unintentional injuries and deaths of children to law enforcement so that parents who allowed negligent access can be charged.
    
2. Limit access to firearms for those who present threats. To fully understand the factors that influence those who use firearms for harm, either for suicide or homicides, we need to invest in database systems with detailed information about firearm-related events that allow a full investigation of the circumstances. Relatedly, databases that communicate with each other are essential, in addition to analytical approaches to follow trends over time. School behavioral threat assessments, which can identify early red flags for individuals in crisis, should be expanded to all school districts. For individuals who recognize that they are in a crisis, temporary voluntary emergency storage should be promoted and supported. Policies should be implemented to support local firearm retailers in providing temporary gun storage and suicide prevention materials. Finally, for individuals who are at the highest risk of hurting themselves or others, extreme risk protection orders should be made available to local law enforcement for the protection of the individual and the community. Provisions to respond to those who violate the protection orders should be included.
    
3. Strengthen support systems for mental health services. Firearm injury impacts not just the injured person, it impacts families and communities. Mental health services are key in addressing the factors leading up to firearm violence and dealing with the aftermath of violence in communities. Improving support systems within communities is essential to responding to firearm injury. School-based programs and increased access to child mental health services within school settings could be instrumental in closing the gap in mental health access. Expanding these services to all school districts would be transformative for Texas children. Telehealth programs that expand the reach of mental health services should be supported as well.
    
4. Strengthen community programs to reduce crime. Firearm injury is devastating to communities, and it is essential to maintain and improve efforts to prevent injuries and reduce the recurrence of firearm incidents. This can be done with effective community-based programs that are adequately funded. Hospital-based violence intervention programs should be mandated at each Level 1 Trauma Center. Increased funding should be allocated for proven community violence reduction strategies, including the use of violence interrupters, anti-gang intervention liaisons, and crime prevention through environmental design. Developing partnerships between community organizations and local municipalities is also key. Moreover, utilizing local datasets and creating linked datasets to accurately assess firearm violence can be instrumental in the reduction of firearm-related crime. Therefore, local municipalities should institute programs that rely on data, and states should fully invest and participate in database programs. Through increased data collection and analysis, community-based intervention programs can be equipped to succeed.

The Baker Institute’s first annual FIPS symposium resulted in a successful collaboration between leaders in science, injury prevention, community organizing, policy and health care. Each session fostered dialogue centered in trust and action with a focus on preventing firearm injury and death. The symposium also resulted in a concrete plan for local action to reduce gun violence within our communities. But to ensure the success of this movement, we need ongoing political and financial commitment to guarantee the safety of our communities and our children.

To learn more about the FIPS program and its annual symposium, visit the event page on the Baker Institute website.

This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s), and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.