Reframe: A public health approach to firearm violence and injury prevention

Communities of interest are developed through respectful relationships among diverse stakeholders inside and outside of health care (e.g., law enforcement, firefighters, community leaders) who have often felt excluded from the conversations and solutions and who share a common interest in reducing firearm injury and death as a preventable health problem. How does this build trustworthiness? AFFIRM builds trusting relationships among health care workers and firearms stakeholders through careful and nonjudgmental listening and communication—a key aspect of trust.

How It Works

AFFIRM’s Reframe model is a practical way to translate scientific research into community-driven, culturally-responsive prevention practices to reduce all forms of firearm injury risk in unique communities. There is often a lack of trust between firearm stakeholders (owners, sellers, trade associations, etc., as well as firearm-owning physicians and patients) and those working to reduce firearm injury and death. Our Reframe model centers the conversation around the experiences of the community, and proposes prevention strategies based on evidence and community partnerships, rather than policy.

The Reframe is unique in that it presents the firearm injury arc – from tragedy to hope – through real stories from members of the community, shared with the community. It backs up these narratives with evidence-based methods for reducing firearm injury. The Reframe conversations serve a dual purpose:

  1. To create a shared sense of purpose and trust, focused on firearm injury as a preventable health problem.
  2. To develop and link evidence-based, health-centric solutions and systems of care. We break down silos, connect local and national resources, and share knowledge and data in ways that resonate with the community.

We are enthusiastic about partnering with healthcare systems and providers across the country to redefine what firearm injury means, and to create new systems of care that prevent it from happening and mitigate its effects.

Skills and Competencies


  1. Storytelling: Inaccurate narratives around firearm injury get in the way of meaningful actions to prevent firearm injury. Our firsthand story-telling fosters a deeper understanding of the root causes of firearm injury, and inspires action towards prevention.
  2. Data acquisition and communication: Sharing evidence about structural, static, and dynamic risk and preventive factors for firearm injury, in a way that is relatable and actionable.


  1. Cultural competence and humility.
  2. A broad understanding of not only healthcare consequences but legal, social and economic consequences for a community.
  3. Development of a commitment to and structures for collaborative work.


In 2017, Dr. Christopher Barsotti (AFFIRM’s CEO) and Dr. Megan Ranney (AFFIRM’s Chief Research Officer) founded AFFIRM Research based on their shared commitment to approaching firearm injury as a public health rather than a political issue. Over the past three years, they have created a national collaborative of medical, public health, nursing, and community organizations dedicated to changing the national conversation about firearm injury. In addition to macro-level, national work, we have led micro-level, community-driven conversations. In this work, “The Reframe,” we have brought together diverse stakeholders, clinicians, and community members to reflect on the very real ripple effects of firearm injury, and to apply the evidence of prevention in ways that resonate with those who are at risk. The Reframe overcomes partisan divides, engages trusted messengers, and creates actionable plans to reduce the incidence and effects of firearm injury on rural and urban communities alike.


Our prior Reframe events in rural and urban settings had strong qualitative effects on trust between different stakeholders (e.g., gun shop owners, nurses, EMS providers, surgeons, research staff, community members). Our Reframe in the Berkshires led to implementation of lethal means counseling in local emergency departments, to numerous radio spots with conservative talk radio stations, and garnered multiple reflections on attendees’ increased openness to addressing firearm suicide as a preventable health problem. Our initial Reframe in Chicago led to multi-trauma-center collaboration on hospital violence intervention programming and research, and led to a recap in October. Preliminary quantitative data (from a non-scientific sample of attendees) suggests positive pre/post changes in knowledge, attitudes, and behavioral intention due to Reframe events. Based on this preliminary data, the Reframe will be tested in 50 4H Shooting Sports Clubs across the country (funded by the CDC) and in multiple rural Missouri hospital systems (funded by the Missouri Foundation). We demonstrate our effect on trust by urban and rural urban communities’ willingness to use our model to tackle this thorny issue.


AFFIRM Research currently provides customized infrastructure and resources to each community, to facilitate and support the development of agendas and storytelling arcs with local stakeholders. As part of our CDC and Missouri Foundation grants, we are building a standard, extensible playbook to allow the Reframe model to be easily scaled in diverse communities across the country. Although each community will choose its own focus, the interconnection of the various types of firearm injury (domestic violence, community violence, suicide, unintentional) allows a salutary effect on all, through trust-based inquiry into any of them.